ORTHODONTIA, 


MALPOSITION  OF  THE  HUMAN  TEETH; 
ITS  PREVENTION  AND  REMEDY. 


BY 

S.  H.  GUILFORD,  A.M.,  D.D.S.,  Ph.D.,       , 

Professor    ok    Opekativf.    anh    Pkostheth     Dentistry    in    the    Philadelphia     Dental 
College;     Author    of    "Nitrous    Oxide,"    &c. 


Approved    hy    the    Xatioiial    A^sot-iation   of    Dental    Faeulties    as   a    text 
book  for  use  in  the  schools  of   its  re])reseutatiou. 


nn i,Ai)K),riii.A^  : 

I'KKSS   OF   SPANtiLKR   it    OAVIS, 

529  COMMRItCK  STUKKT. 


Eutered  according-  to  Act  ol'  Congress,  in  the  year  1889,  by 

S.  H.   GUILFORD, 

In  the  Office  of  the  Lil^rariau  of  Congress,  at  Washington,  D.  C. 


To  My  Father, 

SIMEON  GUILFORD, 

this  work  is 

Affectionately  Inscribed. 


Digitized  by  tine  Internet  Arciiive 

in  2010  witii  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/orthodontiaormal1889guil 


PREFACE. 


Tliis^  work  has  been  written  at  the  rcMjuest  of  the  Na- 
tional Association  of  Dental  Faculties  in  furtherance  of  its 
plan  to  secure  the  preparation  of  a  series  of  text-books  for 
use  in  American  Dental  Colleges.  After  its  completion  and 
examination,  it  was  aece])ted  and  endorsed  by  the  Asso- 
ciation at  its  meeting  in  Saratoga,  August,  1889. 

The  impartment  of  instruction  in  the  simplest  and  most 
direct  manner  being  the  true  province  of  a  text-book,  the 
author  has  endeavored  in  the  preparation  of  this  work  to 
treat  the  subject  as  concisely  as  possible  and  to  clothe  his 
thoughts  and  those  of  others  in  such  language  as  to  be 
readily  comprehended  by  beginners  as  well  as  those  some- 
what advanced  in  this  branch  of  study. 

In  the  treatment  of  the  subject,  the  aim  has  been  to  lead 
the  student  step  by  step  from  the  simplest  beginnings  to 
the  more  complicated  and  difficult  work  of  practical  treat- 
ment. To  this  end,  the  underl3dng  principles  of  the  art  are 
first  elucidated,  after  which  the  principal  methods  employed 
are  explained,  and  lastly  the  correlation  of  principles  and 
methods  is  shown  in  their  practical  application  to  typical 
cases.  In  Part  III,  the  different  forms  of  irregularity, 
together  with  a  variety  of  plans  for  their  correction,  are 
arranged  under  such  headings  and  in  such  order  as  to  be 
readily  referred  to  in  seeking  aid  for  cases  that  occur  in 
ofhce  practice. 


VI  PRKFACK. 

Should  the  work  fulfill  the  object  aiiued  at  in  its  prei)ar- 
atiou.  the  author  will  feel  amply  repaid. 

Credit  for  assistance  is  most  cheerfully  given  to  the 
twenty-five  teachers  of  this  branch  in  American  Dental 
Colleges  who  have  read  this  work  in  manuscript,  and  by 
friendly  criticism  and  valuable  suggestions  added  much  to 
its  completeness. 

The  author  would  also  acknowledge  his  indebtedness  to 
Prof.  W.  F.  Litcli  for  valuable  services,  and  to  the  S.  S. 
White  Co.,  Lea,  Brothers  &  Co.,  P.  Blakiston,  Son  &  Co., 
and  other  publishers  and  authors  for  the  use  of  certain  cuts. 

S.  H.  G. 
Philadelphia,  Sept.,  1889. 


CONTENTS. 


PAKT  1. 

PRINCIPLES  INVOLVED. 

Chap.       I.     Definition  of  Subject, 

"  II.      ETIOL(KiY, 

■''        IIL     Evii.s  Associated  with  Irekgui.akity, 

"        IV.     Advisability  of  Coeuection,        .... 

"  V.     Age  at  which  Cokeection  may  be  begun, 

"        VI.     Movements  to   be   Produced  and    Principles 

Governing  the  Application  of  Force, 
"      VII.     Extraction  as  Related  to  Orthodontia, 
"     VIII.     Physiology  of  Tooth-Movement  and  Char- 
acter OF  Tissues  Involved, 


PACE. 

9 
12 
26 
29 
33 

37 
42 

49 


PART   II. 


MATERIALS  AND  METHODS. 


Chap.       I.     Study  of  Case, 
"  II.     Appliances, 

"        III.     Consideration  of  Methods 
Farrar's  jNIethod, 
Patrick's        " 
Byrnes'  ■• 

Magill  Band, 
Angle's  Method, 
Coffin's        " 
Talbot's       " 


56 
66 

82 
84 
87 
90 
93 
99 
104 


VU 


VI 11  CONTENTS. 

PxVKT    III. 
SPECIFIC  FORMS  OF  IRRE(UTLARITY  AND   THEIR   TJiEATMENT. 


Cpiai*.       I.     IxcisoK  Teeth  Erui'tixg  Outside  ok  Inside  of 
THE  Arch,    ...  .... 

"         II.     Delayed  oe  Mal-erii'tiox  of  the  1'ekmanknt 

Cuspids, 

III.     In'cisor  Teeth  Situated  Outside  or  Inside  of 

the  Arch  after  Dentition  is  comvlete, 
lY.     Cuspid  Teeth   situated  Outside  or  Inside  oi 

the  Arch, 

A''.     Misplaced  Bicuspids, 

VI.     Torsion, 

VII.     Contraction  of  the  Arch, 
VIII.     Protrusion  of  the  Upper  Jaw, 
IX.     Protrusion  of  the  Lower  .Jaw  or  I'rognathism, 
X.     Miscellaneous  : 

Lack  of  Anterior  Occlusion, 

Reduction  of  Elongation  of  the  Anterior 

Teeth, 

Assisted  Eruption  of  the   Anterior  Teeth, 
Tooth  Shaping, 


108 
114 
117 

131 
140 
145 
155 
1(J3 
172 


179 
180 
184 


ORTHODONTIA. 


PART     I-PRINCIPLES     INVOLVED, 


CHAPTER  I. 


DEFINITION   OF   SUBJECT. 


Orthodontia,  from  un/Yu::  straight,  and  uoao:;  a  tooth,  is 
that  branch  of  dental  practice  which  relates  to  the  correction 
of  irregularity  of  position  of  the  Imman  teeth. 

Its  recognition  as  a  distinct  branch  or  speciality  of  gen- 
eral dental  practice  has  come  a1)0ut  in  recent  years,  indeed,  it 
attracted  so  little  attention  less  than  a  century  ago  that  many 
of  the  writers  of  tliat  day  entirely  omitted  it  from  their  Ijooks 
and  writings,  while  those  who  did  refer  to  it  gave  it  but  little 
attention  and  space.  Wliether  the  condition  of  irregularity 
was  less  frequently  met  Avith  then  than  now  we  cannot  cer- 
tainly tell,  but  inasmuch  as  dentistry  was  then  in  its  infancy, 
and  as  the  most  pressing  demands  upon  the  dentist  of  that 
day  were  for  the  alleviation  of  pain,  the  substitution  of  arti- 
ficial dentures  to  replace  lost  members,  and  the  checking  of 
the  ravages  of  decay  l)y  filling,  it  is  but  natural  to  suppose 
that  there  was  little  time  or  inclination  to  attempt  the  relief 
of  so  apparently  unimportant  a  condition  as  mere  irregularity 
of  position.  Since  then,  however,  with  the  natural  growth 
of  dental  science  and  the  enlargement  of  its  sphere,  the  sub- 
ject of  orthodontia  has  grown  in  importance  until  to-day  it 

9 


10  ORTHODOXTIA. 

is  ensfaffiiio-  the  attention  of  some  of  the  best  minds  of  the 
profession  and  forms  one  of  the  most  generally  discussed 
topics  of  dental  gatherings  everywhere,  l^esides  constituting 
an  important  part  of  the  study  of  every  dental  student. 

With  the  growth  of  its  interest  and  importance  there  has 
been  a  corresponding  advance  in  investigation  as  to  the 
cause  and  frequency  of  irregularities,  a  more  exact  micro- 
scopical examination  of  the  tissues  concerned  and  of  the 
physiological  changes  occurring  in  them  in  the  process  of 
correcting  such  conditions :  progress  has  also  been  marked 
by  the  invention  of  a  multiplicity  of  devices  and  appliances 
for  the  more  perfect  and  easy  correction  of  this  class  of 
deformities. 

EEGULARITY   AXD   lEREGULAEITY   DEFINED. 

The  teeth  of  man  when  normally  placed  in  the  alveolar 
arch  describe  in  outline  a  parabola  or  semi-ellipse  with  a 
slight  flattening  of  the  curve  in  the  region  of  the  incisor 
teeth,  and  a  consequent  tendency  to  angularity  where  the 
cu-spids  are  placed.  The  outline  of  the  lower  arch  differs 
from  the  upper  principally  in  the  greater  divergence  of  the 
terminals  of  the  curve.  The  teeth  when  thus  placed  should 
be  in  contact,  each  one  touching  its  neighbors  at  the  mo.st 
prominent  points  of  its  approximal  surfaces.  When  thus 
arranged  the  teeth  are  called  regular. 

An  irregularity  may  be  defined  as  any  variation  from  the 
above  order.  It  may  consist  in  a  variation  from  the  normal 
outline  on  the  part  of  several  or  all  of  the  teeth,  or  in  the 
malposition  of  one  or  more  individual  teeth  ;  if  the  latter, 
the  tooth  or  teeth  may  be  found  outside  or  inside  of  the  reg- 
ular line  of  the  arch  or  they  may  be  placed  anteriorly  or 
posteriorly  to  their  normal  positions,  or  finally,  they  may  be 
turned  or  twisted  on  their  axes.  In  many  cases  this  torsion 
is  associated  with  malposition. 

An  irregularity  being  an  abnormality,  corrective  measures, 
as  a  rule,  .should  be  re.sorted  to,  but  slight  irregularities  do 
not  alwavs  demand  interference. 


PRINCIPLES     IXVOLVED.  11 

The  slight  overlapping  of  the  superior  centrals  by  the  lat- 
erals, for  instance,  is  a  clear  case  of  irregularity,  but  it  is  so 
slight  a  one  and  so  commonly  found  that  it  has  almost  ceased 
to  attract  attention  or  to  be  regarded  as  an  irregularity. 
Artificial  teeth  are  now  made  reproducing  this  condition 
and  in  many  cases  are  preferred  on  account  of  their  "  more 
natural  appearance." 

So  too,  the  slight  irregularity  so  commonly  found  in  con- 
nection with  the  inferior  incisors,  where  several  or  all  of 
them  are  slightly  turned  and  overlapping,  is  no  longer  looked 
upon  as  inharmonious  and  is  also  imitated  in  the  arrange- 
ment of  artificial  teeth. 

Again,  the  slight  misplacement  of  a  tooth  in  the  posterior 
part  of  the  arch,  where  it  is  not  noticeable,  if  it  does  not 
interfere  with  proper  occlusion  or  .specially  invite  decay,  may 
be  left  without  disturbance  and  no  harm  result. 

In  cases  like  these,  if  the  slightly  altered  position  of  the 
individual  teeth  is  not  likely  to  result  in  injury  to  tooth 
structure,  it  is  Ijest  to  omit  anv  effort  toward  correction. 


CHAPTER  II. 

ETIOLOGY. 

Tlie  causes  rcs])Oiisil)k'  for  tlio  production  of  irregularity 
are  many  and  at  l)est  l>ut  imperfectly  understood.  Some  of 
them  are  operative  l)elore  the  birth  of  the  individual  and 
others  afterward.  Tliey  may  therefore  be  classed  under  the 
two  general  heads  of  liereditary  and  acquired. 

HEREDITARY. 

This  class  comprises  all  sucli  cases  as  are  evidently  due  to 
the  inheritance  of  peculiarities  that  existed  in  their  near  or 
remote  ancestors,  or  to  some  of  the  characteristics  of  both 
parents  who  are  themselves  free  from  dental  abnormality. 

The  well-known  l)iological  law  of  transmission  of  charac- 
teristics from  parent  to  cliild  will  readily  explain  how  tlie 
a))normalities  as  well  as  the  normalities  may  be  transmitted. 
The  cliild  may  bear  a  close  resemblance  to  either  }»arent  in 
form  and  feature,  or  it  may  combine  some  of  the  peculiarities 
of  both.  In  other  cases  it  will  resemble  neither,  but  be  like 
one  of  tlie  grandparents  or  other  remote  relations. 

The  evidences  of  inheritance  are  perhaps  nowhere  more 
clearly  expressed  than  in  the  dental  organs.  Not  only  in 
these  organs  as  a  whole  may  we  see  the  dental  ai)paratus  of 
a  progenitor  reproduced  in  entirety,  but  the  resemblance  is 
equally  well  shown  in  the  inheritance  of  so  slight  an  abnor- 
mality as  a  twisted  <<v  misplaced  tootli.  Sometimes  such 
peculi.irity  may  be  inherited  by  sevei'al  children  in  thesame 
family. 

Cases  of  irregulai'ity  due  to  inheritance  are  oftentimes  the 
most  dithcult  to  correct,  for  not  only  must  mechanical  diffi- 
culties be  overcome,  but  in  addition  tlie  influence  of  physi- 
cal  impress,  confirmed   perluqis  l)y   repeated   transmission, 

12 


PRINCIPLES     INVOLVED.  13 

must  be  combattod.  Tlie  mechanical  difficulties  in  sucli 
cases  are  as  readily  concjuered  as  in  others,  but  the  force  of 
inheritance  will  show  itself  in  a  strono;  and  stubborn  ten- 
dency of  the  teeth  to  return  to  their  former  abnormal 
position. 

The  intermarriage  of  races  with  widely  ditferino-  charac- 
teristics has  come  to  l:)e  regarded  as  one  of  the  most  prolific 
causes  of  dental  irregularity.  If  l)oth  races  re])resentcd  in  tJic 
marriage  possess  somewliat  similar  cliaracteristics  as  to  size, 
vigor  and  feature,  no  dental  peculiarity  will  usually  l)e  found 
in  the  offspring;  l)ut  wliere  the  differences  are  marked, 
irregularity  of  the  teeth  will  often  be  the  resulf. 

When  one  parent  possesses  a  large  frame  with  full-sized 
teeth  set  in  large  jaws  and  the  other  a  small  frame  with  cor- 
respondingly small  jaws  and  small  teeth,  the  child  may 
inlierit  the  large  teeth  of  one  parent  and  the  small  jaws  of 
the  other.  The  small  jaws  cannot  accommodate  tlie  full  com- 
plement of  the  larger  teeth  and  hence  a  crowded  and  irreg- 
ular dental  arch  will  be  the  result. 

\Miere  the  small  teeth  of  one  parent  and  the  large  jaws  of 
the  other  are  found  united  in  the  offs})ring,  aljuormal  inter- 
dental spaces  will  fre(piently  be  the  result.  These  spaces 
may  exist  between  all  of  the  teeth,  or,  as  in  some  cases,  the 
deformity  will  only  be  found  in  connection  with  the  anterior 
ones.  ■  Cases  of  this  character,  fortunately,  are  infre(juently 
met  with,  Ijut  when  they  occur  they  present  an  unsightly 
appearance  and  generally  result  in  an  earlier  loss  of  the  teeth 
from  that  lack  of  contact  and  mutual  support  so  necessary 
to  their  longest  retention  and  usefulness. 

ACQUIEED. 

The  causes  productive  of  irregularity  during  dentition  or 
subsequent  to  it  far  exceed  in  num])er  those  due  to  here- 
ditv. 

LONG  RETENTION  OF  DECIDUOUS  TEETH. 

In  accordance  with  physiological  law,  the  deciduous  teeth 
are  intended  to  subserve  the  wants  of  the  child  until  they 


14  ORTHODONTIA. 

are  replaced  by  the  permanent  set.  The  crown  of  the  per- 
manent tooth  should  occupy  a  position  beneath  or  adjacent 
to  the  root  of  the  deciduous  one  which  it  is  intended  to  sup- 
})lant.  Then,  as  the  root  of  the  temporary  tooth  is  gradu- 
ally removed,  the  permanent  tooth  advances  and  finally  occu- 
pies the  position  previou,sly  occupied  by  its  predecessor. 

It  frequently  happens,  however,  that  the  crypt  of  the  per- 
manent tooth  is  situated  at  some  little  distance  from  the  root 
of  its  corresponding  deciduous  one,  and  as  the  new  tooth 
makes  its  way  into  place  it  assumes  a  position  to  the  side  of 
the  deciduous  root.  As  usually  that  part  of  the  root  is 
absorbed  which  is  in  contact  with  the  vascular  covering  of 
the  advancing  crown,  a  portion  of  the  length  of  the  root 
remains  unabsorbed  and  the  new  crown  is,  in  consequence, 
compelled  to  advance  by  the  side  of  the  root  instead  of 
l)eneath  it.  The  deciduous  tooth  as  a  result  of  its  only  par- 
tially absorbed  root,  remains  firmly  in  place  and  the  new 
one  is  erupted  out  of  its  proper  position.  Had  the  condition 
been  brought  to  the  knowledge  of  the  dentist  before  the  new 
crown  appeared,  the  extraction  of  the  deciduous  tooth  would 
have  permitted  the  advancing  tooth  to  assume  its  proper 
position  in  the  arch  and  irregularity  have  been  prevented. 
When  the  permanent  tooth  is  advancing  out  of  position  the 
fact  may  be  recognized  by  the  unusual  distension  of  the  gum 
and  alveolar  plate  beneath,  and  the  deciduous  tooth,  no  mat- 
ter how  firmly  set,  should  at  once  be  removed.  Even  the 
spicula  of  a  deciduous  root  has  been  found  sufficient  to 
deflect  a  permanent  tooth  from  its  course  during  eruption. 

EARLY  EXTRACTION  OF  DECIDUOUS  TEETH. 

That  tlie  premature  extraction  of  deciduous  teeth  often 
prepares  the  way  for  irregularity  of  the  permanent  set  is 
generally  recognized,  but  the  extent  of  its  importance  and 
the  manner  in  which  it  operates  can  best  be  understood  by 
considering  the  |»hysiological  facts  in  the  case. 


PRINCIPLES     INVOLVED.  15 

Irregularity  of  the  deciduous  teeth  is  a  condition  very 
seldom  met  with.  As  a  rule  they  occupy  their  normal  ]^osi- 
tions  in  an  alveolar  arch  of  proper  size  to  accommodate 
them,  and  this  again  rests  upon  a  jaw  l)one  of  suitable 
amplitude.  Thus  jaw,  jn'ocess  and  teeth  are  harmoniously 
correlated.  As  each  deciduous  tooth  is  lost  it  is  succeeded 
by  the  corresponding  permanent  one,  whicli.  under  normal 
conditions,  will  occupy  the  space  made  vacant  by  the  removal 
of  its  predecessor.  In  this  way,  one  by  one,  the  permanent 
set  should  make  its  appearance  until  all  of  the  deciduous 
teeth  have  been  supplanted  by  their  permanent  successors. 

The  permanent  teeth  are  all  larger  than  the  corresponding 
ones  of  the  deciduous  set,  with  one  exception, — the  second 
bicuspid.  This  being  the  case,  they  require  a  larger  alveo- 
lar arch  and  a  correspondingly  larger  jaw  bone  for  their 
accommodation.  This  nature  furnishes  by  the  slow  pro- 
cess of  enlargement  bv  interstitial  groAvth,  wliich  is  hastened 
and  stimulated  by  the  lateral  pressure  of  the  teeth  as  they 
make  tlieir  way  into  j)lace,  and  afterward.  When  the  first 
permanent  molar  makes  its  appearance  it  is  obliged  to 
provide  sufficient  accommodation  for  itself  by  forcing  its 
way  between  the  deciduous  second  molar  and  the  strong 
maxillary  tuberosity  above  or  the  equally  resistant  ramus 
below.  This  pressure  is  felt  by  all  the  other  teeth  in  the 
arch.  If,  therefore,  any  of  the  deciduous  molars  shovild  be 
extracted  about  the  fifth  or  sixth  year,  for  instance,  as  they 
too  often  are  after  having  been  impaired  by  disease,  the 
permanent  molar  will  move  forward  and  occupy  part  of 
the  space  intended  for  the  bicuspids. 

When  the  permanent  lower  central  incisors  erupt  they 
make  their  appearance  inside  of  the  deciduous  ones,  which 
soon  loosen  and  drop  out.  Owing  to  the  fact  that  the  width 
of  these  new  teeth  is  considerably  greater  than  the  space 
occupied  by  their  ^predecessors,  they  naturally  overlap  to  a 
certain  extent  the  adjoining  deciduous  laterals.  This  over- 
lapping prevents  the  centrals  from  moving  forward   into 


16  (MrnioDoxTiA. 

line  in  the  arcli.  \\'hcn  tlie  permanent  laterals  ernpt  they 
assnme  a  position  hy  the  side  of  the  centrals,  and  to  find 
accommodation  in  tliis  contracted  space  inside  of  the  arch 
several  or  all  of  them  are  apt  to  he  crowded  into  irregular 
positions. 

This  condition,  while  perfectly  natural,  from  the  fact 
that  these  teeth  have  erupted  too  rapidly  to  admit  of  a  cor- 
responding increase  in  size  of  the  alveolar  arch,  is  often 
regarded  as  a  serious  evil,  and  to  correct  it,  the  inexpe- 
rienced practitioner  will  in  many  cases  extract  the  tempo- 
rary cuspids  Mdiich  are  designed  for  retention  initil  years 
afterward.  This  additional  space  having  l)een  thus  fur- 
nished, the  permanent  incisors  will  move  forward  into  line 
and  assume  a  regular  position. 

Later,  when  the  hicuspids  appear,  they  will  usually  find 
no  difficulty  in  assuming  places  in  the  arch,  l)ecause  their 
predecessors  occupied  a  larger  space  andl)ccause  the  cuspids 
are  missing,  hut  from  the  very  ahundance  of  the  space  and 
the  pressure  of  the  first  molar  from  behind,  the  bicuspids 
will  very  soon,  if  not  at  once,  be  so  pressed  forward  that  the 
first  bicuspid  will  be. in  contact  with  the  lateral,  leaving  no 
space  for  the  accommodation  of  the  cusj)id  when  it  makes  its 
appearance  at  about  the  eleventh  or  twelfth  year. 

Such  being  the  case  the  cuspid  mnst  of  necessity  erupt 
outside  or  inside  of  the  arch,  and  prodneo  a  deformity  both 
unsiglitly  and  hard  to  correct. 

Had  the  temporai-y  cuspids  not  been  extracted  they 
would  have  jn-eserved  space  for  their  successors,  and  the 
inlocked  and  irregular  incisors,  in  the  course  of  time,  by 
the  normal  enlargement  of  the  arcii,  and  the  excess  provided 
by  the  removal  of  the  deciduous  molars,  would  have  had 
space  sufficient,  Avhich  nature,  assisted  by  the  ])ressure  of  the 
tongue,  would  aid  them  in  occupying. 

The  same  coiulition  is  met  with  in  the  superior  arch,  per- 
haj)s  more  freijuentiy  than  in  the  iid'erior.  Here  the  incis- 
ors erupt  outside  of  tlie  deciduous  ones,  and  sometimes  a})pear 


PRIXCIPLKS     IXVOLVKD.  17 

in  an  irreo-ular  and  crowded  position,  to  correct  wliicli  tlie 
tenii)orary  cuspids  are  often  needlessly  sacrificed,  and  the 
same  train  of  evils  follows. 

It  will  thus  be  seen  that  the  premature  extraction  of  any 
of  the  temporary  teeth,  especially  the  cuspids,  cannot  well 
result  in  other  than  harm  to  the  permanent  ones,  so  far  as 
regularity  is  concerned. 

Sir  John  Tomes  relates  a  case  in  which  he  extracted  for 
cause  all  of  the  deciduous  teeth  of  a  child,  and  yet  when 
the  })ermanent  ones  a])})eared  they  assunuMl  their  i)ro})er 
positions  in  the  arch  without  any  resultant  irregularity. 

This  one  case,  however,  the  only  one  of  the  kind  on 
record,  does  not  disprove  the  facts  as  noticed  in  tliousands 
of  cases  of  opposite  character,  nor  does  it  confute  the  plainly 
api)arent  workings  of  physiological  law.  It  simply  illus- 
trates what  nature  may  do  in  a  single  case  under  conditions 
exceptionally  favorahle. 

INJUDICIOUS   EXTRACTION   OF   PERMANENT   TEETH. 

A  condition  frequently  met  with  after  all  the  })crmanent 
teeth  have  l)een  erupted,  is  one  where  in  the  u})per  jaw  the 
centrals,  l.)icus})ids  and  molars  are  all  harmoniously 
arranged,  while  the  laterals  occupy  a  position  inside  of  the 
arch  and  the  cuspids  lie  .outside  of  it.  The  condition  is 
most  frec{uently  brought  about  l)y  the  premature  extraction 
of  one  or  more  members  of  the  temporary  set,  as  descril»ed 
under  the  last  heading. 

To  remedy  the  difficulty  in  the  easiest  manner,  some 
practitioners  have  at  times  extracted  the  laterals  and 
on  other  occasions  the  cuspids.  Tlie  result  has  been  in  each 
case  an  almost  hopeless  deformity.  The  cuspids  l)rought 
next  to  the  centrals  oftentimes  gives  to  the  face  a  canine 
appearance,  while  Avith  cuspids  lacking  the  countenance  is 
robbed  of  that  prominence  near  the  angles  of  the  mouth  so 
necessary  to  harmonious  expression. 

Again,  the  first  permanent  molars  of  one  of  the  jaws  are 


18  ORTHODONTIA. 

often  neglected  until  caries  has  made  serious  inroads  upon 
them,  when  they  are  extracted  as  offending  members.  The 
result  is  that  the  lateral  pressure,  so  necessar}^  to  proper 
expansion  of  the  process  is  lacking  in  one  jaw,  while  in  the 
other  the  normal  enlargement  continues.  As  a  consequence 
there  is  disparity  of  proportion  between  the  two  jaws,  and 
the  appearance  of  the  individual  is  perhaps  permanently 
marred. 

DELAYED  ERUPTION  OF  PERMANENT  TEETH. 

It  sometimes  happens,  from  causes  not  easily  definable, 
that  the  eruption  of  one  or  more  of  the  permanent  teeth  is 
retarded  to  sucli  a  degree  that  the  rest  of  the  set  take  posi- 
tions in  the  arch  and  occupy  all  the  space.  When  the 
tardy  member  is  ready  to  erupt  there  is  no  place  for  it,  and 
it  is  compelled  to  take  a  position  outside  or  inside  of  the 
line.  This  is  apt  to  occur  more  frequently  with  the  cuspids 
than  any  of  the  other  teeth,  although  it  is  occasionally  met 
with  in  the  case  of  the  laterals  and  bicuspids. 

ACCIDENTS. 

An  accidental  injury  to  one  or  more  of  the  teeth  of  either 
set,  whether  resulting  in  their  loss  or  not,  is  often  respon- 
sible for  an  irregular  condition.  Should  a  deciduous  tooth 
become  devitalized,  as  the  result  of  an  accident  or  otlier 
cause,  and  alveolar  abscess  su})ervene,  the  physiological  act 
of  ab.sorption  will  be  suspended,  and  the  succeeding  tooth 
in  the  course  of  its  eruj)tion  will  naturally  be  deflected  from 
its  course  and  erupt  in  an  al)normal  position. 

So,  also,  it  has  hap]»ened  that  a  deciduous  incisor,  through 
a  fall,  has  been  driven  up  into  the  j^rocess.  Such  a  mis- 
fortune can  hardly  fail  to  cause  an  injury  to  the  partially 
formed  iiernianciit  tootli  lying  Ix'ncath  it.  Should  no  more 
serious  result  follow  it  will  jtrobably  at  least  divert  the  course 
of  the  new  tooth  and  be  productive  of  an  irregularity. 

The  author  had  one  such  case  in  his  practice  with  an 
irregularly  ]»lacetl  [termaiient  t(»oth  as  the  result. 


rRINCIPLES     INVOLVED.  19 

HABITS. 

The  bad  habits  which  young  children  are  apt  to  acquire 
after  they  are  weaned,  such  as  thumb-,  lip-  or  tongue-sucking 
are  important  factors  in  bringing  about  an  irregular  align- 
ment of  the  teeth  in  one  or  more  portions  of  the  arch. 
Acquired  early,  while  the  temporary  teeth  are  in  position 
and  firmly  set,  the  habit  will  usually  make  no  inqu'ession 
upon  them,  but  if  not  checked  and  allowed  to  continue  up 
to  the  time  of  the  coming  of  the  permanent  set,  as  is 
frequently  the  case,  these  will  generally  be  thrown  out  of 
position  or  be  so  altered  in  their  relationship  as  to  cause  a 
serious  deformity. 

This  is  readily  accounted  for  when  we  consider  that  the 
erupting  teeth,  seeking  their  position  in  the  arch  and  sur- 
rounded by  newly  formed  and  pliable  alveolar  tissue,  are 
easily  turned  out  of  their  course  by  any  extraneous  force 
exerted  upon  them. 

The  general  results  of  the  triple  habit  are  the  same, 
although  they  vary  in  particulars.  In  thumb-sucking, 
usually  only  two  or  three  of  the  incisors  are  pressed  out  of 
place,  and  the  ones  affected  are  determined  by  the  hand 
used  and  the  position  of  the  thumb  in  the  mouth.  In  lip- 
and  tongue-sucking,  owing  to  the  larger  surface  of  the  organ 
employed,  all  of  the  incisors  will  be  affected. 

Not  only  has  the  point  of  introduction  of  the  thumb  to  be 
considered  in  relation  to  its  effects,  but  also  the  angle  at 
which  it  is  held.  When  the  position  of  the  thumb  in  rela- 
tion to  the  teeth,  forms  less  tlian  a  right  angle,  the  upper 
teeth  will  be  thrown  out  and  the  lower  ones  in ;  but  when 
held  in  a  horizontal  position,  the  upper  and  lower  teeth  are 
not  displaced  but  sinq)ly  lield  apart.  As  a  result  of  this 
latter  position  the  first  molars  are  kept  from  present  contact 
and  naturally  elongate  until  in  time  they  come  together. 
The  mouth  is  thus  permanently  propped  apart  in  front 
and  when  the  second  molars  erupt  and  come  into  occlusion 
the  ill-condition  is  confirmed.     With  these  ei2:ht  firm  teeth 


20 


ORTHODONTIA. 


in  contact,  there  is  no  longer  any  liope  of  the  ten  anterior 
ones  elongating  sufficiently  to  meet,  and  we  have  the 
deformity  known  as  "  lack  of  anterior  occlusion,"'  which  is 
not  only  a  disfigurement  but  a  serious  disadvantage  to  the 
individual  in  mastication.  This  lack  of  anterior  occlusion 
is  not  always  due  to  the  habit  of  thumlj-sucking,  for  it  may 
be  Ijrought  al:)Out  by  physical  peculiarities,  as  noticed  in 
Part  III.,  Chapter  X. 

In  lip-sucking  the  lower  lij)  is  drawn  into  the  mouth 
over  the  lower  teeth,  and  held  there  for  varying  periods 
both  day  and  night.  The  result  is  that  by  the  force 
thus  exerted  the  lower  teeth  are  thrown  in  and  the  upper 
ones  out  to  .such  an  extent  as  to  give  them  an  unnatural 
jDrominence,  and  to  cause  spaces  to  exist  between  them. 

Fig.  1  illustrates  this  condition.  The  chil<l.  v/hen 
brought    to    the  author  Fig.  1. 

for  c  o  n  suit a.t  ion,  was 
twelve  years  of  age  and 
a  confirmed  victim  in 
the  habit  of  lip-sucking. 
All  of  tiie  fourteen  teeth  in 
e  a  c  h  j  a  w  w  e  r  e  f  u  1 1  y 
erupte.l  and  nicely  in  line,  ^ 

except  the  eversion  and  introversion  of  the  upper  and  lower 
incisor  teeth  respectively.  The  teeth  were  brought  into 
i:)roper  position  and  the  habit,  by  Ijeing  thus  made  impos- 
ed )le,  was  broken  up. 

But  the  displacement  and  failure  of  occlusion  of  teeth  in 
tlie  anterior  part  of  the  mouth  are,  hoAvever,  not  the  only  evils 
a.ssociated  Avith  this  habit  in  its  three  forms.  In  each  case 
the  jaws  are  held  temporarily  a})art  so  that  there  could  l)e  no 
occlusion  of  the  teeth  even  thougli  they  occluded  normally 
when  the  jaws  were  closed.  This  leaves  the  side  teeth  free 
to  change  their  position  if  any  iidhience  is  exerted  to  pro- 
duce that  result.  In  the  act  of  sucking,  the  checks  are  drawn 
in  and  the  strong  j)ressure  thus  In-ought  to  l)ear  upon  the 


PRINCIPLES     INVOLVED. 


21 


Fig. 


bicuspids  and  (occasionally)  the  first  molars,  causes  them  to 

be  bent   inward.     In  this  mal-position  they  are  frequently 

confirmed  by  the  opportunity  thus  given  the  other  molar 

teeth  to  move  forward, 

of  which  they  are  not 

slow  to  take  advant- 

ao-e.    The  rt^sult  is  the 

deformity  known  as 

the  "  saddle-shaped  " 

jaw,    as   shown  in 

Fig-.  2. 

This  deformity,  pro- 
duced l)y  the  same 
causes,  may  be  pres- 
ent in  the  lower  jaw, 
but  it  is  much  less  i^ 
frequently  met  with  » 
tliere    than     in     the 

\ip"[)ei'.  Saddle-sliaped  .\reh,  (after  Coleman.) 

The  condition  may  also  be,  and  undoubtedly  frequently 
is,  due  to  other  causes  or  conditions. 

Mr.  Charles  Tomes  ascribes  the  cause  of  this  defurmit}^  as 
well  as  that  known  as  the  "  V-shaped  arch,"  to  enlarged  ton- 
sils, which  by  partially  closing  the  posterior  nares  necessi- 
tates breathing  with  the  mouth  open.  In  this  case  as  in 
lip-sucking,  the  .jaws  are  kept  apart  and  the  contraction  of 
the  muscles  of  the  cheeks  lias  in  consequence  a  tendency  to 
deflect  the  Ijicuspids  inward. 

Irregular  eruption  of  tlie  permanent  teeth  is  also  a  cause 
tendino-  to  l)rino;  al)out  this  condition.  In  some  cases  the 
cuspids  erupt  and  assume  their  positions  in  the  arch  before 
one  or  both  of  the  bicuspids  make  their  appearance.  When 
the  latter  erupt,  there  is  insufficient  space  for  their  accom- 
modation. Their  effort  to  force  themselves  into  position  is 
met  and  opposed  by  the  more  firmly  set  cuspids  and  first 
molars,  and  in  consequence  they  are  forced  to  take  a  position 


22  ORTHODONTIA. 

inside  of  the  arch,  making  the  diameter  of  the  mouth  at  this 
point  less  than  anywhere  else,  thus  constituting  a  true  saddle- 
shaped  condition. 

This  deformity,  according  to  the  author's  observation,  is 
never  inherited,  l)ut  always  acquired. 

IRREGULAEITIES  OR  DEFORMITIES  WITH  MIXED  ETIOLOGICAL 
CHARACTERISTICS. 

There  are  some  typical  malformations  of  the  teeth  and  jaws 
the  causes  of  which  cannot  be  classed  under  either  the 
hereditary  or  the  acquired  form,  but  combine  certain  features 
of  both. 

Among  the  more  prominent  of  these  are,  protrusion  of  the 
upper  jaw,  prognathism,  and  the  "  V-shaped  "  arch. 

SUPERIOR   PROTRUSION. 

In  this  condition  the  lower  anterior  teeth  may  be  some- 
what introverted  or  they  may  be  in  line  forming  their  por- 
tion of  a  normal  arch,  while  the  superior  ones  project  forward 
and  outward  to  such  an  extent  as  to  leave  a  space,  more  or 
less  great,  between  their  cutting  edges  and  those  of  the  lower, 
thus  producing  a  marked  deformity  and  giving  to  the  in- 
dividual a  slightly  imbecile  exi:)ression.  The  lower 
anterior  teeth,  when  the  jaws  are  closed,  may  not  occlude 
with  their  fellows  above  or  they  may  rest  in  contact  with 
the  bases  of  their  crowns  instead  of  touching  nearer  the 
cutting  edges. 

In  most  cases  this  deformity  is  Ijut  the  e'xpression  of  a 
tendency  inherited  from  a  progenitor  under  conditions  favor- 
able to  reproduction.  It  may  also  be,  and  in  many  cases 
doubtless  is,  the  result  of  meclianical  causes  finding  mani- 
festation in  the  individual  alone.  Even  if  inherited  it  must 
have  l)een  the  result  of  such  causes  in  the  individual  with 
whom  it  originated. 

In  some  instances  we  find  it  associated  with  abnormally 
large  incisors,  especially  the  centrals,  which  could  find  accom- 


PRINOIPLKS     INVOLVED. 


23 


modation  only  by  enlargement  of  the  arch,  while  in  others 
it  bears  evidence  of  being  the  result  of  an  over-develoi:)nient 
of  the  superior  or  an  under-development  of  the  inferior  arch. 

It  may  also  be  caused  by  the  mal-eruption  of  certain  of 
tlie  posterior  teeth,  permitting  them  to  assume  a  position 
one  tooth  in  advance  of,  or  posterior  to  their  normal  place ; 
such  a  condition  would  tend  to  restrain  the  lower  teeth 
from  pressing  forward  and  cause  the  upper  ones  to  advance 
unnaturally. 

The  condition  also  may  appear  exaggerated  in  cases  where 
from  some  cause  the  lower  incisors  are  inclined  inward,  thus 
causing  the  upper  ones  to  seem  more  protruded  than  they 
reallv  are. 

PROGNATHISM. 

This  deformity,  consisting  in  the  abnormal  protrusion  of 
the  inferior  teeth  and  jaw,  is  one  very  frequently  met  with ; 
it  gives  to  the  individual  somewhat  of  a  canine  expression, 
and  for  this  reason  is  very  aptly  designated  by  the  Germans 
as  Hundemaul.  In  some  cases  the  lower  anterior  teeth  an- 
tagonize with  the  superior  ones  but  pass  just  outside  of  them, 
while  in  others  the  lower  jaw  and  teeth  are  protruded  to  such 
an  extent  as  to  make  the  occlusion  of  the  lower  anterior  and 
side  teeth  a  physical 
impossibility.  Fig.  3 
represents  an  extreme 
case  of  this  character. 
The  deformity  is  not 
only  very  unsightly, 
but  interferes  serious- 
ly with  mastication. 
It  may  be  induced  by 
any  cause  or  causes 

that  tend  to  lessen  the  Excessive  protrusion. 

extent  of  contact  in  occlusion.  That  the  lower  jaw  possesses 
an  inherent  tendency  to  move  forward  when  occlusion  does 
not    prevent    is    abundantly    shown    in    cases   where   the 


Fig.  3. 


24 


OKTHODOXTIA. 


individual  lias  become  edentulous  and  no  artificial  teeth 
are  Avorn.  Even  the  occlusion  of  artificial  teeth  will  lessen 
or  check  this  tendency. 

In  many  cases  it  is  an  undoul)ted  iidieritance,  while  in 
others  it  may  1)e  1)rou,<j,ht  al)Out  by  local  conditions.  It  is 
liable  to  occur  in  all  cases  where  it  is  not  prevented  by  me- 
chanical influences. 

y-SHAPED  AECH. 

The  angular  or  A'-sliaped  arch  is  not  an  uncommon  one. 
In  a  typical  arch  of  this  character,  tlie  teeth  instead  of  form- 
mg  an  arch,  are  arranged  in  two  straight  but  divergent  lines, 
which  meet  at  an  angle  where  the  central  incisors  join  each 
other.  The  molars,  bicuspids  and  cuspids  are  usually  proper- 
ly related  to  one  another,  but  simply  thrown  inward,  forming- 
straight  lines  instead  of  curves.  Tlie  incisors,  liowever,  by 
this  contraction  of  the  space  are  not  only  thrown  forward 
but  turned  upon  their  axes  so  tliat  their  lingual  surfaces 
present  toward  each  other.  Fig.  4. 

Fig.  4  ^'  represents  thisform 
of  irregularity.  It  is  in 
all  cases  confined  to  the 
superior  maxilla,  the  lower 
one  being  usually  harmo- 
nious in  outline.  T  h  e 
pressing  forward  of  the  in- 
cisor teeth  and  their  tor- 
sion often  gives  such  prom- 
inence to  the  lip  that  the 
teeth  remain  exposed  even 

when  the  jaws  are  closed.  v-siiaped  aicIi. 

In  addition  to  this  unsightliness,  the  speech  is  often  seriously 
affected  by  the  free  and  uneonti-ollable  escape  of  air  when 
articulation  is  attempted. 

The  causes  responsible  for  this   condition  are  i)robal»ly 


*Froiii  a  model  in  tlie  collection  of  Dr.  W.  F.  Fundeuberg. 


rUTXCIPLES     INVOLVED.  25 

shrouded  in  greater  obscurity  tlian  tliose  of  any  other  form 
of  irregularity. 

The  crowding  of  teeth  during  ei'U})tion  ;  dehiyed  eruption  ; 
imperfect  or  excessive  maxillary  development  or  mal-occlu- 
sion  ;  some  of  which  are  evidently  responsible  for  many  forms 
of  irregularity,  cannot  be  called  to  account  for  this  condition, 
for  none  of  tliem  could  press  the  teeth  into  such  symmetri- 
cally straight  lines.  The  most  plausible  hypothesis  which 
has  yet  been  advanced  in  regard  to  it  is  that  of  Mr.  Charles 
Tomes,  who  believes  that  it  is  brought  about  by  the  pressure 
of  the  muscles  of  the  cheeks  upon  the  sides  of  the  arch  while 
sleeping  with  the  mouth  open,  and  that  this  habit  is  due  to 
enlargement  of  the  tonsils,  which  prevents  full  breathing 
through  the  nose. 

The  pressure  of  the  cheeks  covering  so  large  a  surface 
would  l)e  just  the  kind  of  force  that  would  be  likely  to  pro- 
duce this  symmetrical  contraction  of  the  arch,  l)ut  the  author's 
observation  does  not  lead  him  to  coincide  with  Mr.  Tomes 
in  the  belief  that  it  is  usually  associated  with  enlarged  ton- 
sils. Many  persons  breathe  with  their  mouths  open,  and  this 
habit,  which  may  be  due  to  a  variety  of  causes,  seems  likely 
to  be  a  factor  in  producing  this  peculiar  condition ;  but  the 
author  Ijelieves  that  the  deformity  is  one,  the  tendency  to 
which  is  usuallv  inherited. 


CHAPTER  III. 

EVILS  ASSOCIATED  WITH  IRREGULAEITY. 

Ill  order  to  properly  appreciate  the  importance  of  the  cor- 
rection of  irregularity  of  the  teeth,  it  will  be  well  to  consider 
in  brief  detail  some  of  the  more  prominent  evils  associated 
with  the  condition. 

APPEARANCE   MARRED. 

While  this  result  is  usually  not  the  most  important  of  those 
connected  with  irregularity,  it  is  the  one  which  most  gener- 
ally induces  tlie  patient  to  apply  for  remedial  treatment. 
The  other  evils  may  not  be  recognized  or  may  l)e  considered 
of  minor  importance  by  the  parent,  but  the  ill-appearance 
of  the  child  both  attracts  the  attention  and  enlists  the 
sympatliy  to  such  an  extent  as  to  create  a  desire  for  its 
improvement. 

The  external  deformity  caused  by  an  irregularity  will  be 
greater  or  less  according  to  its  extent  and  location.  If  it  be 
slight  in  character  and  located  l)ack  of  the  cuspid  teeth  it 
will  usually  give  no  external  evidence  of  its  existence,  but 
if  kjcated  in  the  anterior  part  of  the  mouth,  it  will,  even  if 
slight,  be  very  noticeable  and  in  consequence  constitute  a 
source  of  annoyance  to  the  individual  throughout  life. 

The  class  of  irregularities  most  noticealde  under  all  con- 
ditions is  that  where  the  form  of  the  arch  is  altc>red,  thus 
changing  in  a  marked  degree  the  entire  facial  expression. 
Such  deformity  cannot  be  masked.  It  mu.st  either  be 
mechanically  reduced  or  stoically  endured. 

SPEECH  AFFECTED. 

This  re.suh  like  tlic  preceding  one  will  be  slight  or  aggra- 
vated according  to  circniiistaiices,  l»iit  when  at  all  consider- 
able it  |ii-oclaiiiis  itself  to   the   world    with   every  attempt  at 

2(i 


I'RlNCirLES     INVOLVED.  27 

speech  in  so  iiiij)lcasaiit  a  manner  as  to  be  a  painful  annoy- 
ance to  both  speaker  and  listener. 

It  may  be  due  to  the  restriction  of  the  movements  of  the 
tongue  as  in  a  narrow  or  contracted  arch,  to  alteration  of 
tlie  form  of  the  roof  or  vault  of  the  mouth  where  the  sides 
of  the  latter  have  assumed  a  deep  pitch  resulting  in  the 
formation  of  a  sharp  angle  along  the  median  line  of  the 
palate,  or,  it  may  be,  and  most  usually  is,  due  to  the  uncon- 
trollable escape  of  air  between  the  teeth  in  the  anterior  part 
of  the  mouth  by  virtue  of  the  non-apj^roximation  of  those 
teeth  and  the  change  of  form  in  that  part  of  the  alveolar 
ridge  which  aids  the  tongue  in  the  production  of  perfect 
sounds. 

MASTICATION    IMPAIRED. 

In  most  cases  of  irregularity,  either  simple  or  complicated, 
there  is  a  corresponding  degree  of  either  mal-occlusion 
or  lack  of  occhision.  In  simple  cases,  or  where  but  few  teeth 
are  throwm  out  of  occlusion  it  may  not  occasion  any  incon- 
venience to  the  individual,  Init  where  the  irregularity  is  at 
all  extensive  so  many  teeth  are  usually  lacking  in  occlusion 
as  to  seriously  impair  the  power  of  mastication. 

When  this  latter  condition  prevails  it  is  most  likely  to 
result,  sooner  or  later,  in  injury  to  other  organs,  for  where 
mastication  is  imperfectly  performed  greater  demand  is  made 
upon  the  stomach  to  prepare  the  food  for  digestion  and 
assimilation.  The  stomach  soon  feels  the  effect  of  this 
over-taxation  and  becomes  weakened  in  tone,  which  may 
finally  result  in  incapacitating  it  for  the  performance  of  its 
normal  functions. 

Teeth  that  do  not  occlude  are  of  no  use  to  the  individual 
for  purposes  of  mastication,  and  those  that  occlude  but 
slightly  or  imperfectly  possess  very  slight  value. 

As  one  of  the  principal  functions  of  the  teeth  is  mastica- 
tion, and  as  all  the  teeth  are  needed  to  perform  this  work 
satisfactorily,  it  naturally  follows  that  any  interference  with 
this  function,  through  irregular  position  or  otherwise,  must 


28  ORTIIODOXTIA. 

be  (Ictrimontal   to   the   individual  and   fiv(|ueiitly  result  in 
partial  or  eoni})le(e  loss  of  lu^altli. 

CARIES   INDUCED. 

The  human  teeth  are  arranged  in  the  jaws  in  such  man- 
ner as  to  best  subserve  the  wants  of  the  individual,  and  their 
form  and  location  are  also  such  as  to  conduce  to  the  greatest 
immunity  from  caries  and  their  consequent  longest  endur- 
ance. 

Their  rounded  approximal  surfaces  and  the  constriction 
of  their  necks  reduces  the  point  of  contact  with  their  fellows 
to  the  minimum.  As  their  liability  to  approximal  decay 
is  in  proportion  to  the  amount  of  surface  in  contact,  it  wdll 
be  seen  that  tliose  normally  placed  are  likely  to  be  freest 
from  the  ravages  of  caries. 

Wlien,  therefore,  the  teeth  occupy  irregular  positions, 
especially  where  the}'  are  crowded,  more  of  the  surface  of 
each  tooth  is  in  contact,  and  the  liability  to  decay  is  corres- 
pondingly increased.  This  is  true  of  irregularly  placed 
teeth  in  any  part  of  the  arch,  but  the  liability  is  greatly  in- 
creased where  crowding  or  overlapping  exists  among  the 
incisor  teeth,  for  owing  to  their  flattened  form  it  is  possible 
for  more  of  their  surface  to  be  in  contact  with  their  fellows 
than  would  be  possiljle  with  any  of  the  other  teeth. 

In  such  cases,  with  the  condition  uncorrected,  teeth  decay 
and  re-decay  in  spite  of  the  most  faithful  efforts  of  the  dentist 
until  tliev  are  finallv  lost. 


CHAPTER    IV. 

ADVISABILITY  OF  CORRECTION. 

With  our  advanced  knowledge  in  regard  to  the  teeth  and 
their  surrounding  tissues,  and  the  advancement  made  of 
recent  years  in  the  muhiplication  and  perfection  of  mechan- 
ical appliances,  scarcely  any  deformity  of  the  mouth  and 
teeth  is  beyond  mechanical  remedy.  ^Mth  possibility  assured, 
however,  it  is  most  important  that  we  should  consider  care- 
fully the  (piestion  of  advisability,  for  what  is  possible  may 
not  always  be  advisable.  There  are  several  considerations 
that  enter  into  this  question  of  advisability. 

AGE. 

The  age  of  tlie  patient  lias  much  to  do  with  the  advisa- 
l)ility  of  any  pr()})0sed  operation  for  correction.  Early  in 
life,  when  the  alveolar  tissues  have  not  yet  reached  the  hard- 
ness and  density  of  structure  which  they  will  attain  at  a 
later  period,  they  are  more  easily  operated  upon.  They  are 
elastic  and  readily  yield  to  pressure,  and  at  tlie  same  time 
under  the  influence  of  this  pressure  they  are  more  quickly 
resorbed  and  thus  give  way  to  the  tooth  that  is  being 
moved.  This  feature  of  early  youth  is  an  important  and 
valuable  one  in  that  it  renders  an  operation  for  correction 
more  easy  of  accomplishment,  but  with  it  is  also  linked  an 
element  of  adverse  influence  which  must  not  be  overlooked. 

While  the  soft  and  easily  yielding  process  favors  the 
operation,  it  is  at  the  same  time  a  tissue  poorly  fitted  to  resist 
the  influences  which  often  operate  to  again  displace  the 
tooth.  For  this  reason,  a  tooth  moved  at  an  early  age  is 
often  liable  to  subsequent  displacement  when  the  ])ressure 
caused  by  the  eruption  of  the  succeeding  teeth  is  brought  to 
bear  upon  it. 

29 


30  OKTIIODONTIA. 

After  maturity,  we  have  the  conditions  exactly  reversed. 
The  densei"  and  more  perfectly  cakitied  process  yields  less 
readily  to  pressure  and  absorption,  l)ut  \\'hen  the  tooth  has 
once  been  moved  into  proper  position  it  is  more  easily  and 
firmly  held  there  by  the  surrouiidino'  tissues. 

In  view  of  these  facts  it  will  readily  be  seen  that  in  many 
cases,  especially  where  the  proposed  operation  is  simple  in 
character,  and  where  the  result  ol)tained  is  not  likely  to  be 
nullified  by  subsequent  events,  interference  early  in  life  is 
advisable,  but  where  the  operation  is  to  be  extensive  in 
character  and  tlie  result  difficult  to  secure  against  subsequent 
adverse  influences  (such  as  the  eruption  of  the  later  teeth) 
2:)rudence  would  suggest  non-interference  until  all  of  the 
fourteen  teeth  of  the  involved  jaw  have  eru2:)ted. 

HEALTH. 

The  health  and  strength  of  the  patient  at  the  time  of  any 
proposed  operation  for  irregularity  is  so  important  a  consid- 
eration that  it  must  not  be  disregarded.  The  time  that  is 
generally  considered  most  favoral^le  for  correction  (between 
the  ages  of  thirteen  and  eighteen  years)  is  also  a  period 
when  important  changes  are  going  on  in  the  entire  economy. 
The  individual  is  passing  from  the  stage  of  childhood  into 
that  of  manhood  or  womanhood,  and  in  this  change, 
especially  in  tlie  case  of  the  female,  the  life-forces  are  taxed 
to  the  utmost.  At  this  time  also  the  mental  faculties  are 
being  sev(^rely  strained  by  study,  in  consequence  of  which,  if 
the  i)hysi('al  culture  of  the  individual  be  neglected,  as  it  too 
often  is,  the  nervous  .system  becomes  unduly  exalted. 

To  meet  and  partially  compensate  for  these  drains  upon 
the  system  it  is  mo.st  important  that  full  luitrition  be  sus- 
tained. To  do  this  with  teeth  that  are  sore  or  tender  to  the 
touch  fi'oiii  being  moved  is  impos.sible,  and  hence  the  system 
will  be  still  further  weakened  1)V  lack  of  nourishment  if  any 
severe  operation  be  undcilakcii. 

.\t  this  jx'riod  (tf  life,  tlMTcfoi'c,  uuless  the  patient  i»oss('sses 


PRINCIPLES     INVOLVED.  31 

vital  powers  of  a  lii<ih  order,  it  might  V)e  unwise  to  further 
tax  his  or  her  system  by  any  extensive  operation  for  cor- 
rection that  would  involve  the  intliction  of  much  })ain, 
discomfort  or  annoyance.  Should  tlie  vitality  of  the  patient 
be  below  the  average,  no  dithcult  or  protracted  operation  for 
correction  should  l)e  undertaken,  for  it  might  result  in  per- 
manent impairment  of  the  health. 

It  is  much  better  to  postpone  the  operation  until  a  time 
when  the  vital  powers  can  stand  the  strain,  or  if  necessary 
abandon  it  altogether,  for  the  loss  of  healtli  can  never  be 
compensated  for  by   any  benefit  conferred  u})on  the  dental 

organs. 

SEX. 

The  sex  of  the  in<lividual  must  also  be  considered  in  con- 
nection with  this  subject.  The  consideration  of  sex  may  be 
disregarded  so  tar  as  the  desirability  of  an  operation  is  con- 
cerned— for  if  the  results  of  neglected  irregularity  are  harm- 
ful in  respect  to  one  sex,  they  are  certainly  equally  so  in 
regard  to  the  other — but  as  regards  the  necessity  for  inter- 
ference the  question  of  sex  is  an  important  one.  Correct 
facial  expression  and  harmony  of  feature  are  far  more  im- 
portant to  the  female  than  to  tlie  male ;  for,  Ijeing  endowed 
by  Nature  with  greater  beauty  of  form  and  feature  than  man, 
its  absence  in  any  part  is  more  noticeable  than  it  would  be 
in  the  sterner  sex.  Besides  this,  after  youth  is  passed,  man 
has  in  the  hairy  covering  of  the  lip  a  means  of  concealing 
most  deformities  of  the  dental  arch,  while  woman  is  entirely 
without  this  advantage.  For  these  reasons  the  necessity  for 
the  correction  of  any  irregularity  of  the  teeth  seems  more 
imperative  in  woman  than  in  man. 

POWER  OF  APPRECIATION. 

The  intelligence  of  the  patient  and  his  ability  to  })roperly 
appreciate  any  benefit  conferred,  are  important  considerations 
in  enabling  us  to  determine  whether  or  not  to  undertake  any 
considerable  operation  for  the  correction  of  irregularity. 


o2  OKTHODONTIA. 

Orthodontia,  at  best,  is  a  most  dififtcult  undertaking,  and 
frequently  lacking  in  suitable  pecuniary  reward,  so  that  the 
lover  of  the  art  must  nearly  always  depend  upon  apprecia- 
tion for  part  of  his  compensation.  If  this  be  wanting,  the 
operation  is  robbed  of  nearly  or  quite  all  of  its  attractive- 
ness, and  the  stimulus  to  success  is  absent. 

There  are  those  whose  want  of  intelligence  or  lack  of  cul- 
ture ^vould  lead  them  to  regard  with  much  indifference  any 
irregularity  of  their  teeth,  and  who  if  they  were  beneiited 
b}"  our  efforts  for  correction  would  fail  to  appreciate  the  ben- 
efit conferred.  For  such  it  would  be  manifestly  unwise  to 
urge  or  encourage  any  difficult  or  extensive  operation  for 
correction  even  though  they  might  be  able  to  compen- 
sate us  pecuniarily  for  our  labor,  for  they  would  be  likely 
either  to  give  up  the  operation  when  partially  completed  or 
fail  to  wear  any  appliance  for  retention,  and  thus  permit  fail- 
ure to  follow  success. 

FAMILY   TYPE. 

A^^len  any  great  deformity  of  the  teeth  and  jaws,  such  as 
anterior  protrusion  of  either  jaw  or  a  ^^-shaped  arch  is  shown 
to  be  hereditary,  it  is  well  to  take  into  consideration  the 
hereditary  feature  of  the  case  before  beginning  any  opera- 
tion for  correction.  Where  the  irregularity  is  known  to  have 
been  acquired  in  the  parent  of  the  child  and  thus  to  have 
been  transmitted  but  once,  the  difficulties  in  the  case  are  not 
so  marked  because  the  type  has  scarcely  been  confirmed  ;  but 
where  it  has  been  transmitted  througli  two  or  more  genera- 
tions the  impress  is  strong  and  difficult  to  overcome. 

In  the  latter  case  tlie  correction  of  the  deformity  will  not 
be  more  difficuH  than  usual,  l)ut  after  correction  the  ten- 
dency of  perverted  nature  to  cause  a  return  to  the  family 
type  will  be  so  strong  as  to  almost  baffle  us  in  our  attempts 
to  preserve  the  advantage  we  have  gained.  Under  such  cir- 
cumstances the  retaining  a]>])liance  will  have  to  be  worn  a 
very  long  time,  and  a  constant  watch  kept  over  the  case 
until  we  are  sure  that  the  result  will  be  permanent. 


CHAPTER  A'. 

AGE  AT  WHICH  CORRECTION  MAY  BE  BEGUN. 

The  correction  of  invn'ularities.  under  favoring  conditions, 
may  be  begun  and  carried  forward  successfully  through  a 
wide  range  of  years. 

It  may  be  undertaken  as  early  as  the  eighth  or  ninth  year, 
and  again  may  yield  successful  results  as  late  as  the  thirty- 
fifth  year  or  later.  The  operation  is  one  largely  dependent 
upon  the  absorption  and  re-formation  of  bone,  and  as  new 
bone  will  form  at  almost  any  period  of  life,  as  evidenced  by 
the  reunion  of  a  fracture,  so  the  correction  of  an  irregularity 
is  possible  at  quite  a  late  period. 

The  correction  of  irregularity,  however,  would  usually 
prove  so  slow  and  tedious  an  operation  after  the  maximum 
of  density  had  been  attained  in  the  })rocess,  and  the  neces- 
sity for  it  be  so  much  lessened  by  advancing  age,  that  the 
advisability  of  undertaking  it  would  be  (juestionable. 

The  most  favorable  time  for  correction  in  cases  as  they 
usually  present  is  between  the  ages  of  thirteen  and  eighteen. 
Earlier  tlian  this  the  operation  is  advisable  under  certain 
circumstances,  and  later  the  difficulties  increase  with  the 
years. 

WHEN   EARLY   INTERFERENCE   IS   JUSTIFIABLE   AND 
ADVISABLE. 

Any  of  the  |)ermanent  teeth  may  erupt  outside  or  inside 
of  the  areh.  If  allowed  to  remain  in  such  i)Osition  for  any 
length  of  time,  the  space  intended  for  their  accommodation 
will  soon  be  partly  occujiied  by  the  adjoining  teeth,  and 
the  subsequent  correction  of  the  irregularity  rendered  more 
difficult.  So  also  a  central  or  lateral  incisor  often  erupts  in 
such  manner  that  its  cutting  edge,  instead  of  being  in  lino 
with  the  curve  of  the  arch,  forms  an  angle  witli  it. 


ORTHODONTIA. 


Fig.  5. 


Torsion  and  Overlapping. 
Fig.  6. 


Torsion  \\ith  Space. 


This  tor.'^iou  may  l)e  as.sociated  with  an  overhipping  of  tlie 
adjacent  tooth  as  shown  in  Fig.  o,  or  there  niay  be  a  space 
between  the  two  as  shown  in  Fig.  (i. 

In  eithei"  case  tlie  twisted  tooth 
occupies  a  less  space  at  the  line  of  the 
cutting  edge  than  it  should.  By  al- 
lowing this  condition  to  remain,  when 
the  pressure  of  the  later  erupting 
teeth  begins  to  be  felt,  these  teeth 
will  be  pressed  still  closer  togetlier 
and  the  irregularity  be  confirmed. 
>Subsec][uent]y,  Avhen  the  correction 
of  the  condition  is  attemjDted,  there 
will  not  l)e  sutticient  room  to  accommodate  the  tooth  in  its 
wider  aspect  and  the  adjoining  teeth  will  have  to  be  pressed 
apart  or  the  arch  expanded  to  obtain  the  necessary  room; 
while,  if  the  tooth  had  been  turned  in  its  socket  before  the 
eruj)tion  of  the  other  teeth  the  operation  would  have  been  a 
very  simple  one. 

Again,  when  an  incisor  erupts  so  as  to  occupy  a  position 
inside  of  the  arcli  in  the  upper  jaw,  or  outside  of  it  in  the 
lower,  and  tlie  tooth  he  held  in  such  |)Osition  by  the  antag- 
onizing teetli,  immediate  interference  and  correction  is 
demanded  in  order  to  prevent  the  complications  that  would 
result  from  the  partial  or  complete  closure  of  the  si)ace 
intended  for  the  accommodation  of  the  malposed  tooth. 
The  su]ierior  central  incisors  sometimes  erupt  in  such 
a  niannci'  that  their  cutting  edges  form  an  angle  at  the 
median  line.  To  neglect  tlic  condition  or  to  postpone  its 
correction  will  not  only  result  in  its  confirmation  and  prob- 
able aggravation,  l)ut  may  also  ojx-n  the  way  for  a  complete 
change  in  the  slia]:)e  of  the  arch. 

It  is  entirely  jirobable  that  certain  arches  of  a  modified 
Y-sha])e  have  Ix'cn  formed  in  this  way.  In  cases  such  as 
those  just  mentioned,  early  interference  is  the  wiser  plan,  but 
it  is  equally  im})ortant  that  after  they  have  been  j)laced 


PinXCII'LKS     IXVOLVKD.  35 

propoi'ly  ill  lino  tlicy  should  he  tirnily  held,  not  only  until 
new  bony  tissue  has  hirii  fonncd  around  them,  Init  until  the 
lateral  pressure  of  the  neii>h1)C)rin2;  teeth  coming  into  place 
has  spent  itself. 

How  this  may  be  readily  and  successfully  done  will  ai)[)ear 
in  the  consideration  of  practical  cases  in  Part  III. 

In  the  lower  jaw  the  conditions  are  somewhat  (Uflerent. 
The  incisors,  u})on  eruption,  generally  })resent  a  somewhat 
crowded  and  irregular  condition,  which  is  ])artly  or  entirely 
corrected  by  nature  in  the  enlargement  of  the  arch  and  the 
influence  of  the  lip  and  tongue  in  l)ringing  them  into  a  more 
harmonious  outline. 

Interference  with  them  is  not  called  for,  if  at  all,  until  a 
hiter  period. 

At  best,  the  attempt  to  correct  an  irregularity  during  the 
earlier  period  of  permanent  dentition  should  usually  be  con- 
fined to  one  or  two  teeth  ;  if  anything  more  extensive  is 
called  for,  it  should  be  delayed. 

WHEN  CORRECTION   SHOULD  BE   DELAYED   UNTIL   DENTITION 
IS   COMPLETE. 

xVs  a  rule,  any  extensive  o})eration  for  the  correction  of 
irregularity  involving  a  number  of  teeth,  should  not  be 
undertaken  until  all  of  the  permanent  teeth  (excepting  the 
third  molars)  are  fully  erupted.  When  a  single  incisor  is 
malposed  with  no  prospect  of  its  being  able  to  take  its  place 
in  the  arch  unaided,  and  every  prospect  of  its  being  confirmed 
in  its  malposition,  the  necessity  for  immediate  interference 
is  plainly  evident ;  l)ut,  where  a  numl^er  of  teeth  are  mal- 
posed it  is  not  so  ea.sy  to  prognosticate  what  effect  their  cor- 
rection may  have  when  considered  in  relation  to  tlie  teeth 
still  to  be  erupted.  The  result  is  naturally  involved  in  some 
doubt.  Even  if  the  necessity  for  correction  a})])ears  evi- 
dent to  us  and  we  should  acc()m})lish  it,  the  result  may  be 
wholly  undone  by  later  influences  which  could  not  have 
been  foreseen. 


36  ORTHODONTIA. 

Under  sucli  circumstances  it  is  wise  to  delay  interference 
until  tlie  permanent  teeth  are  in  place  and  the  arch  fully 
expanded,  when  by  a  careful  examination  of  all  tlie  condi- 
tions we  can  easily  foresee  the  result  of  any  proposed  opera- 
tion and  decide  intelligently  not  only  what  needs  to  be  done, 
but  also  the  best  way  of  accomplishing  the  desired  result. 
Oftentimes  this  later  examination  will  show  that  the  irregu- 
larity has  much  improved  and  the  necessity  for  interference 
is  consequently  lessened. 

The  line  of  distinction  between  the  advisability  of  early 
and  late  interference  is  plainly  marked  and  slioiild  not  be 
lost  sight  of,  for  a  mistake  in  either  case  would  necessarily 
bring  about  unfortunate  results. 


CHAPTER  VI. 

MOVEMENTS  TO  BE    PRODUCED   AND   PRINCIPLES   GOVERNING 
THE  APPLICATION  OF  FORCE. 

In  causing  mal})osc<l  teetli  to  assume  their  proper  positions 
in  the  arch  certain  movements  are  necessary,  and  to  pro])erly 
accompHsli  tliem  forces  must  l)e  In'oug'lit  to  l)ear  in  a  manner 
best  calculated  to  i)roduce  the  desired  result.  Tlie  usual 
movements  that  teeth  undergo  in  being  forced  into  position, 
are  outward,  inward,  forward,  l)ackward  and  rotary.  Some- 
times but  one  movement  is  necessary  in  the  case  of  a  single 
tooth,  but  more  frequently  several  are  required  before  proper 
alignment  is  secured. 

The  application  and  regulation  of  force  in  producing 
movements  of  the  teeth  are  governed  largely  by  the  general 
principles  of  applied  mechanics. 

TJie  greatest  f/ood  can  he  obtained  from  any  force  oidy  ivJioi  if  is 
exerted  in  a  direct  litie  with  the  movement  desired. 

To  this  end,  in  the  selection  or  application  of  any  devices 
for  the  moving  of  teeth,  preference  should  be  given,  caeteris 
parihna,  to  those  that  are  most  direct  in  their  action. 

The  application  of  direct  force,  however,  is  not  always 
possible  owing  to  the  position  the  power-producing  instru- 
ment would  have  to  occupy  in  the  mouth,  and  tlie  conseijuent 
interference  (as  in  the  loAver  jaw)  it  would  cause  in  limiting 
the  movements  of  the  surrounding  or  adjacent  organs.  P^)r 
this  reason  we  very  frequently  have  to  consent  to  the  use  of 
some  form  of  appliance  that  will  yield  power  in  a  line  that 
is  not  direct,  but  still  effective. 

The  force  used  mast  he  snfficiod,  hnt  not  excessive,  and  not  too 
ahmptJj/  applied. 

If  the  force  Ije  insufficient  to  accomplish  the  desired  object 
the  result  would  not  only  be  a  failure  but  it  would  also 

37 


38  OUTIIODOXTIA. 

involve  a  serious  waste  of  the  time  of  bi)tli  })atieiit  and  oper- 
ator;  whereas,  if  it  were  more  than  suttieient  it  mi^lit  cause 
a  fracture  of  one  of  the  alveolar  plates,  a  ru})ture  of  a  blood- 
vessel at  the  apical  foramen,  or  a  constriction  of  the  entire 
])ul})  at  tlie  same  point,  resulting  in  its  devitalization. 

!So,  also,  in  the  widening  of  the  arch ;  if  the  force  be  too 
great  or  too  suddenly  applied  it  is  liable  to  result  in  the  sepa- 
ration of  the  superior  maxillary  bones  at  the  palatal  suture. 
The  greatest  23rudence  an.d  care  are  necessary  in  the  ai)plica- 
tion  of  force- to  the  teeth. 

Hie  jjoiids  of  resistance  and  deViverij  of  tlie  force  must  he  fixecl 

points. 

The  point  of  resistance,  or  in  other  words  the  point  selected 
to  resist  the  strain  of  an  appliance  while  it  is  being  exerted 
to  cause  movement  at  some  other  point,  must  necessarily  bo 
fixed  and  immovable,  for  if  it  be  not  so,  fully  one  half  or 
more  of  the  force  expended  will  be  lost.  Xot  only  this,  but 
if  the  anchor  tooth  or  teeth  should  yield  at  all  to  the  pres- 
sure they  would  be  ])ressed  out  of  place  and  thus  one  irregu- 
larity would  be  created  in  our  attempt  to  correct  another. 

No  factor  in  orthodontia  is  more  important  than  this. 

So,  also,  the  point  of  delivery  must  be  a  fixed  point.  B}^ 
a  fixed  point  in  this  sense,  is  meant  one  that  will  receive  the 
force  in  such  a  way  that  none  of  it  will  1)e  lost.  As  the 
intended  tooth  is  moved,  the  jjoint  on  its  surface  where  the 
force  is  delivered  will  necessarily  move  with  it,  but  it  should 
be  so  arranged  that  in  this  movement  the  i;()int  of  delivery 
be  not  changed.  A  change  at  this  point  will  be  as  disas- 
trous, and  frefjuently  more  so,  than  at  the  point  of  resistance, 
for  if  tlie  ai>i)liance  slij)  or  change  its  position,  the  force  will 
be  exerted  in  a  line  different  from  that  inteiidi'd  and  harm 
will  always  result. 

(ireat  difficulty  was  formerly  experienced  in  making 
attachments  for  ajipliances  so  that  they  might  be  innuovably 


pi;tx('ti'[-i:s    txvolved.  30 

]\v\(\  wIktc  placed,  l)ut  since  tlie  introduction  of  tlie  platinnni 
band  by  1  )v.  Abi^iH,  difficulty  of  this  character  has  been 
overcome. 

The  reiiistaiicc  at  the  poi id  from  which  we  exert  pressure,  must  Ix- 
f/rcc(ter  ilmn  fJic  ir.sisfdnce  to  be  overcome  by  the  pressure. 

The  truth  and  inij)ortance  of  this  statement  would  seem 
to  be  self-evident. 

Our  points  of  resistance  usually  consist  of  one  or  more 
teeth  situated  at  some  distance  from  the  one  intended  to  be 
moved.  (Jccasionally,  a  single  tooth,  if  it  l)e  multi-rooted 
or  one  with  a  long  root  firmly  implanted,  will  be  sufficient 
for  our  anchorage,  provided  the  tooth  to  be  moved  be  single- 
rooted  and  of  not  too  great  resisting  power;  l)uta  tooth  with 
a  single  root  will  seldom  l)e  sufficient  for  anchorage  in  mov- 
ing any  other  tooth.  A  single  molar,  firmly  implanted,, 
may  sometimes  be  sufficient  to  offer  resistance  in  the  moving 
of  a  bicuspid  or  incisor,  but  it  is  always  better,  if  jiossible,, 
to  have  the  resistance  divided  among  several  teeth. 

A  cuspid  should  never  be  depended  upon  to'  resist  alone 
the  force  needed  to  move  another  cus})id,  for  it  is  as  likely 
that  the  one  will  be  moved  out  of  as  the  other  into  place. 
The  force  of  resistance  should  always  be  as  much  distributed 
as  possible,  for  the  sake  of  safety. 

It  should  at  ways  be  seen  to,  in  adronrc,  tliat  tliere  is  xiifficicid  space 
to  accomniod(de  tlie  tooth  in  the  ucw  jtosition  it  is  to  occupy. 

The  importance  of  this  precautionary  measure  will  be 
readily  seen.  Unless  there  be  room  to  accommodate  a  tooth 
we  will  either  fail  in  our  efforts  to  move  it  or  succeed  only 
by  the  expenditure  of  an  amount  of  force  out  of  all  propor- 
tion to  the  reciuirements  of  the  case.  Instead  of  moving  one 
tooth  we  may  under  such  circumstances  have  to  move  sev- 
eral at  the  same  time,  a  difficult  and  oftentimes  unnecessary 
undertaking. 

If  sufficient  room  does  not  exist  naturallv,  we  can  increase 


40  ORTHODONTIA. 

it  by  .-separating  tlie  adjoining-  teeth.  If  tlie  .space  alread}' 
existing  be  too  great  to  admit  of  the  use  of  rubber  wedges, 
the  object  can  be  accomplished  by  the  use  of  wood,  or  other 
suitable  substance. 

The  method  advocated  1;)y  one  writer  to  accomplisli  tliis 
result  by  means  of  a  double-ended  screw  with  face-clamps, 
is  lK)tli  uiniecessarily  complicated  and  less  efficient. 

In  many  cases  where  a  tooth  is  locked  out  of  place  the  jaAV 
needs  or  will  bear  expansion  as  well.  In  such  cases,  of 
course,  we  expand  the  arch  first,  and  this  will  afford  us  room 
to  bring  the  tooth  into  position. 

An  exception  to  this  rule  is  sometimes  found  in  the  case 
of  a  lower  incisor  placed  slightly  within  the  arch  and  held 
there  by  the  adjoining  teeth.  As  these  teeth  are  usually 
easily  moved  it  will  not  be  necessary  to  provide  room  in 
advance,  for,  if  our  point  of  resistance  be  sufficient,  we  can, 
by  the  use  of  a  jack-screw,  readily  force  the  tooth  into  line, 
notwithstanding  the  overlapping  of  adjoining  teeth.  An 
illu.stration  of  this  method  is  shown  in  Fig.  11.  p.  (J4. 

Pressure  may  be  either  constant  or  interrupted. 

The  question  of  the  use  of  either  constant  or  interrupted 
pres.sure  in  the  regulation  of  teeth  did  not  arise  until  Dr. 
Farrar  declared,  a  numl»er  of  years  ago,  that,  according  to 
physiological  law,  direct  and  intermittent  pressure  was  the 
only  kind  suitable  to  be  applied  in  the  moving  of  teeth. 

The  only  way  in  which  direct  and  intermittent  force  can 
be  applied  is  by  the  use  of  the  screw  in  one  of  its  various 
forms.  Continuous  pressure  is  that  which  we  obtain  from 
the  elasticity  of  the  metals,  from  rubber,  either  partially  or 
fully  vulcanized,  and  from  the  expansion  of  wood,  sea-tangle 
or  other  like  substances.  The  action  of  these  substances 
cannot  well  be  interrupted  to  provide  a  period  of  rest,  but 
they  continue  their  action  until  the  force  they  are  designed 
to  exert  has  been  spent. 

Tho  screw  is.  in  manv  cases,  one  f»f  the  Itcsf  methods  l)y 


rRiN'cirr.Ks    jnvolvkd.  41 

wliicli  to  exert  pressure,  but  it  eaunot  be  ai)[)lie(l  to  advan- 
tage ill  all  eases.  To  limit  ourselves  tberelbre  to  its  use, 
would  be  to  deny  ourselves  the  advantage  to  be  gained  by 
the  employment  of  the  various  substances  previously 
enumerated. 

So  far  as  the  author  is  aware  no  one  has  advocated  the 
exclusive  use  of  constant  i)ressure,  but  those  who  believe  in 
and  make  use  of  it,  also  use  the  interrupted  pressure  in  the 
form  of  the  screw,  not  because  of  its  interrui)tability  but 
because  of  its  directness  and  power. 

Experience  has  shown  that  by  continuous  ])ressure  equally 
good  results  have  been  produced  as  by  uninterrupted  pres- 
sure and  witli  as  little  harm.  Those  who,  like  tlie  author, 
have  used  both  kinds  according  to  the  seeming  requirements 
of  the  case  in  hand,  have  been  uiudde  to  notice  any  advant- 
age in  the  one  over  the  other  as  viewed  from  a  physiologi- 
cal standpoint. 

Dr.  Atkinson  has  recently  exjiressed  liis  belief  that  continu- 
ous pressure  in  regulating  most  fully  stimulates  tlie  action 
of  the  osteoclasts  in  the  absorption  of  alveolar  tissue. 

Pressure  sltould  be  exerted  as  nearhj  as  possible  in  a  line  at  right 
angles  to  the  long  axis  of  the  tooth. 

By  the  application  of  power  in  this  way  the  best  results 
are  accomplished.  If  the  power  be  applied  at  a  slight  angle 
from  above,  no  harm  will  result,  as  it  will  only  serve  to  keep 
the  tooth  in  its  socket  while  it  is  being  moved,  but  if  applied 
at  an  angle  from  below,  the  tendency  will  be  to  lift  the  tooth 
from  its  socket  and  serious  complications  may  ensue. 

This  last  result  is  most  liable  to  follow  the  use  of  a  jack- 
screw  applied  at  an  improper  angle,  when  by  its  direct 
and  excessive  power  the  tooth  may  be  lifted  up  and  par- 
tially dislodged. 


CHAPTER  Vir. 

EXTRACTION  AS  RELATED  TO  ORTHODONTIA. 

Probabl}'  no  feature  in  the  practice  of  Orthodontia  is  more 
important,  or  has  associated  with  it  greater  possibilities  for 
good  or  evil  to  the  patient  than  that  of  extraction. 

As  related  to  the  prevention  or  correction  of  irregularity, 
extraction  on  the  one  hand  may  l)e  of  the  greatest  possible 
benefit  or  on  the  other  it  may  result  in  irreparal)le  injury. 

Judicious  extraction,  if  undertaken  in  time,  will  often 
forestall  or  prevent  an  irregular  condition  of  the  teeth,  and 
in  other  cases  it  will  assist  greatly  in  simplifying  the  opera- 
tion of  correction.  Occasionally,  it  is  all  that  is  called 
for  on  our  part,  nature  performing  the  rest  of  the  operation 
unaided. 

Injudicious  or  ill-advised  extraction,  however,  may  com- 
plicate and  render  most  difficult  the  correction  of  cases 
which  in  themselves  were  not  difhcult,  or  it  may  even  be  the 
immediate  cause  of  a  deformity  which  would  not  otherwise 
have  existed. 

The  paramount  importance,  therefore,  of  knowing  when 
to  extract,  and  when  not,  will  l)e  readily  recognized. 

To  properly  convey  to  the  student  a  fair  understanding 
of  these  circumstances,  in  as  concise  and  comprehensive  a 
manner  as  possible,  it  lias  1)een  thought  best  to  formulate  the 
following  rules  : 

Always  avoid,  if  possible,  extracting  o.nij  of  tlie  six  anterior  teetJt, 
in  the  superior  arch. 

We  would  iiigc  Ibis,  ])ecause  it  is  nearly  always  unneces- 
sary to  cxtracl  lliciii,  and  because  their  absence,  owing  to 
tbeir  promiiieiit  position,  would  be  more  noticeable  than 
that  (jf  oflier  teelh    in   tlie    nioulh.      If   tlie  anterior  teeth 

42 


I'KINCIPLKS     INVOLVED.  43 

bo  sound  and  only  irregular  in  position,  the  extraction  of  a 
bicuspid  from  one  or  both  sides  will  usually  give  us  sufficient 
room  for  spreading  the  anterior  teeth  and  moving  them  into 
their  proper  })ositions. 

It  has  happened,  however,  to  the  author  and  others,  to 
meet  with  eases  where  the  superior  laterals  were  locked  inside 
of  the  arch  by  the  close  approximation  of  centrals  and  cus- 
pids, and  where  the  laterals  were  withal  so  badly  injured 
by  decay  and  disease  as  to  render  their  usefulness  doubtful 
if  brought  into  line.  In  such  few  cases  it  was  deemed  best 
to  extract  the  laterals,  especially  as  their  absence  would  not 
be  more  noticeal)le  afterward  than  before,  and  because  there 
was  good  occlusion  between  the  rest  of  the  teeth  in  the 
mouth. 

The  author  ha<l  two  cases  in  one  year  present  to  him  for 
the  reduction  of  protrusion  in  the  anterior  superior  teeth.  In 
each  case  there  was  a  broken  or  badly  diseased  right  cen- 
tral incisor  that  was  beyond  hope  of  preservation.  In  these 
cases  it  did  not  ha}){)en  [)articularly  amiss,  for  the  extraction 
of  the  roots  attbrded  room  for  drawing  in  the  remaining  five 
teeth,  thus  easily  reducing  the  deformity  and  at  the  same 
time  closing  the  space.  The  appearance  of  the  patient  in 
each  instance  was  greatly  improved,  and  the  absence  of  even 
so  large  a  tooth  as  the  central  was  scarcely  noticeable. 

In  the  cases  just  mentioned  it  must  be  borne  in  mind  that 
advantage  was  simply  taken  of  an  existing  condition  to  sim- 
plify an  operation.  Had  the  teeth  been  good,  it  would  have 
been  criminal  to  extract  them. 

In  another  case,  a  girl  eleven  years  of  age  had  lost  a  right 
superior  central  incisor  through  a  fall  from  a  swing.  Two 
days  after  the  accident,  and  when  the  tooth  had  been  mislaid 
or  thrown  away,  she  was  })rought  for  treatment.  Only  two 
methods  of  remedying  the  difficulty  suggested  themselves. 
One  was  the  wearing  of  an  artificial  tooth  ;  the  other,  draw- 
ing the  teeth  together  to  close  the  space.  The  latter  plan 
was  decided  upon,  and  successfull}'^  carried  into  effect ;  but, 


44  ORTHODOXTTA. 

unfortunately,  as  there  had  been  no  protrusion  before  and 
there  was  contraction  afterward,  the  superior  teeth  no  longer 
overla[)pcd  the  lower  ones,  Init  met  them  edge  to  edge,  thus 
giving  the  upper  jaw  a  flattened  ai)pearance,  which  was  in 
itself  a  deformity.  The  patient  was  saved  the  annoyance  of 
wearing  an  artiticial  tooth,  but  her  facial  expression  was 
injured  in  consequence. 

Such  cases  as  those  just  alluded  to  are  exceedingly  rare, 
and  are  only  mentioned  as  extraordinary  exceptions  to  a 
very  good  rule.  Aside  from  the  centrals,  there  is  probably 
less  excuse  for  the  extraction  of  the  cuspids,  than  any  of 
the  anterior  teeth,  and  yet  it  is,  unfortunately,  too  often  re- 
sorted to. 

If  for  any  cause,  the  cuspids  erupt  al)normally,  and  there 
is  no  room  for  them  in  the  arcli,  if  it  be  not  advisable  to 
expand  the  arch,  one  of  the  bicuspids  on  each  side  should 
be  extracted  to  make  room  for  them.  The  cuspid  being  the 
stronger  and  more  durable  tooth  of  the  two,  it  should  be 
given  the  preference  in  the  struggle  for  existence.  More  than 
this,  owing  to  its  long  and  prominent  root  it  gives  a  char- 
acteristic expres.sion  to  the  face,  and  if  it  be  lost  the  expres- 
sion will  be  irretrievably  lost  with  it.  The  first  bicuspid 
proves  a  very  poor  substitute  for  it  in  every  way. 

Ill  tJie  lower  jaw  one  of  the  incisors  hkhj  sometimes  he 
extracted  to  f/aia  space. 

Slight  irregularity  or  crowding  of  the  inferior  incisors  is 
of  such  common  occurrence  as  to  have  almost  become  the 
rule  in.stead  of  the  exception.  Their  partial  concealment, 
together  witli  the  usual  freedom  of  the  condition  from  ill 
results,  causes  any  interference  to  seem  meddlesome  rather 
than  otherwise,  if  the  irregularity  be  trifling.  In  cases,  how- 
ever, where  the  crowding  is  excessive  and  calls  for  correc- 
tion, it  is  usually  tlie  easier  and  better  plan  to  extract  one 
of  the  implicated  teeth  and  bring  the  others  together  into 
line.     The  four  teeth  are  so  nearly  alike  in  size  and  charac- 


PRINCIPLES     INVOLVED.  45 

ter,  that  the  loss  is  not  usually  noticed  when  one  has  been 
removed.  It  is  sometimes  perplexing  to  decide  which  of  the 
four  to  extract,  but  the  one  most  out  of  line,  and  in  conse- 
quence the  one  that  will  create  the  least  sj)a('(>  by  its  removal, 
shoultl  usually  be  selected. 

Ill  respect  to  the  loss  of  the  inferior  cuspid,  the  same  re- 
marks apply  as  to  its  fellow  in  tin>  ()p})osite  jaw. 

Bacl:  of  tJte  anterior  teeth,  if  all  are  eqiiolli/  gond  and  one  invst 

he  rcmoinK  ^ehrt  the  one  nearest  (nid  posterior  to  the 

one  out  of  position. 

As  so  large  a  proportion  of  the  irregularities  we  are  called 
upon  to  correct  })ertain  to  the  anterior  teeth,  and  as  it  is  so 
advisable  to  retain  these,  extraction  for  room,  when  neces- 
sary, generally  falls  upon  one  of  the  teeth  posterior  to  the 
cuspids.  Which  of  these  it  is  best  to  extract,  to  make  room 
for  a  malposed  cuspid  or  incisor,  has  been  a  sul)ject  of  con- 
troversy among  })ractitioners  for  many  years. 

Some  have  claimed  that  as  the  statistical  tables  show  the 
first  molar  to  be  by  far  the  least  durable  of  all  the  permanent 
teeth,  it  should  generally  be  selected  as  the  one  to  be  sacri- 
ficed. Others,  on  the  contrary,  have  contended  that  as  the 
first  and  second  bicuspids  are  both  frail  teeth,  and  are  often 
lost  early  in  life,  and  as  from  its  greater  size  the  first  molar 
is  so  much  more  valuable  in  mastication,  it  should  be 
preserved  and  one  of  the  l)icuspids  removed. 

There  is  truth  in  botli  of  these  arguments,  l)ut  we  feel 
satisfied  that  under  the  conditions  named,  all  e(iually  good 
at  the  time,  wisdom  will  dictate  the  removal  of  the  one  near- 
est the  point  of  ditficulty,  for  in  so  doing  we  greatly  simplify 
the  operation  for  correction  and  effect  a  saving  all  around. 
Simplicity  in  surgical  as  well  as  mechanical  matters  is  a 
great  desideratum.  Indeed,  it  not  infrequently  happens  that 
where  a  cuspid  is  out  of  line  the  first  bicuspid  assumes  its 
place  in  the  arch,  so  that  if  we  were  to  extract  the  first 
molar,  both  first  and  second  bicuspids  would  have  to  be 


46  ORTHODONTIA. 

moved  out  of  their  position  of  good  occlusion  into  a  space 
further  back,  a  feat  very  difficult  and  oftentimes  well-nigh 
impossible  of  accomplishment.  By  the  simple  extraction  of 
the  first  bicuspid  in  such  cases,  the  cuspid  will  usually  fall 
into  its  place  without  any  assistance. 

If  a  tooth  other  than  the  one  nearest  to  that  in  malposition  he 

defective,  and  not  too  far  distant  from  point  of  irregularity, 

extract  it  instead. 

The  second  molar,  decayed  or  sound,  is  usually  too  far  dis- 
tant to  be  available  by  its  extraction  in  furnishing  room  for 
the  movement  of  anterior  teeth.  If  the  bicuspids  be  sound 
and  the  occlusion  does  not  interfere  witli  their  backward 
movement,  the  first  molar,  if  very  defective,  may  be  extracted 
in  preference  to  a  sound  tooth  in  advance  of  it. 

So,  too,  if  the  second  bicus^Did  be  carious  or  defective  and 
the  first  one  healthy,  the  former  should  for  the  same  reason 
be  extracted. 

If  a  tooth  must  he  lost,  either  to  allow  a  more  important  one  to 

f(dl  into  line  or  to  create  space,  it  should  he  done  ivithout 

delay  to  accomplish  tJte  hest  results. 

When  a  cuspid  erupts  Avithout  room  in  the  arch  for  its 
accommodation,  and  the  circumstances  of  the  case  point  to 
the  extraction  of  the  first  bicuspid  to  make  place  for  it,  the 
sooner  the  extraction  takes  place  the  better.  If  the  opera- 
tion be  delayed,  the  cuspid  in  its  endeavor  to  force  its  way 
into  place  will  often  press  so  hard  upon  the  lateral  as  to  force 
it  inward,  and  if  possible  under  the  central,  thus  creating  an 
additional  irregularity.  Such  results  have  often  been  noticed . 
Prompt  extraction  after  it  liad  become  necessary  would  liave 
changed  the  condition. 

In  similar  manner,  when  it  becomes  advisable  to  extract 
one  or  more  of  the  first  molars  to  prevent  the  further  expan- 
sion of  the  jaw  or  to  abort  a  threatened  irregularity  in  the 
anterior  part  of  the  arch,  it  is  best  not  to  delay  their  extrac- 


PRINCIPLES     INVOLVED.  47 

tion  too  loiio-.  They  sliould  not  \)v  iwtracted  before  the  sec- 
ond bicuspids  arc  in  })laee,  but  it  they  must  be  lost,  they 
should  be  removed  after  the  erui)ti()n  of  the  latter  teeth  and 
before  the  second  molars  ai)})ear,  somewhere  about  the 
eleventh  or  twelfth  year.  If  longer  delayed  the  harm  we 
wished  to  prevent  (ex})ansion  of  the  jaw)  will  have  been 
accomplished  and  their  later  extraction  will  not  avail.  If 
extracted  about  tlie  time  the  second  molars  are  erupting,  tlie 
latter  will  glide  naturally  into  the  s})ace  formerly  occupied 
by  the  extracted  teeth  ;  tliis  tliey  are  not  so  a[)t  to  do  later 
on. 

If  a  tooth  must  be  removed  on  one  side  to  obtain  space  it  does  not 

necessarily  folloiv  that  its  mate  on  the  opposite  side  slundd 

also  be  extracted. 

If  there  be  the  same  reason  for  extracting  l)oth,  as  where 
the  existing  evil  pertains  as  much  to  one  .side  as  to  the  other, 
let  both  be  extracted ;  but  where  tlie  trouble  sought  to  be 
remedied  is  confined  to  one  side,  the  extraction  of  a  tooth  on 
that  side  ought  not  to  be  supplemented  by  a  useless  extraction 
on  the  other.  Those  who  favor  symmetrical  or  double 
extraction  claim  that  it  prevents  the  disturbance  of  the 
median  line,  but  it  has  been  our  experience  that  the  extrac- 
tion of  a  tooth  back  of  the  cuspid  will  not  often  affect  the 
central  line  through  the  moving  of  the  teeth  toward  the 
space,  and  even  a  slight  disturbance  of  that  line  is  far  less 
objectionable  than  the  sacrifice  of  a  valuable  tooth. 

Where  there  is  disparity  in  size  between  tlie  two  jaws,  and  two 
teeth  need  to  be  extracted  from  the  more  prominent  one,  it 
would  be  a  serious  mistake  to  extract  also  the  cor- 
responding teeth  in  tlie  other  and 
smcdler  jaw. 

It  would  seem  almost  impossible  to  make  such  a  mistake, 
and  yet  that  it  has  been  made  time  and  again,  the  mouths 
we  are  called  upon  to  examine  often  bear  sad  evidence.     It 


48  OKTIIODOXTTA. 

occurs  through  hick  of  kiiowledgc,  want  of  judgment,  or 
erroneous  teaching. 

When  those  of  long  practice  advise,  without  qualification, 
that  at  eleven  years  of  age  the  four  first  molars  should  be 
extracted,  it  is  scarcely  to  be  wondered  at  that  some  young 
practitioners  sliould  lose  confidence  in  their  own  better  judg- 
ment and  be  led  astray.  Harm  of  this  nature,  wlien  once 
done,  can  never  be  undone,  and  the  patient  is  injured  beyond 
repair. 

Needless  cxtmction  should  he  carefully  guarded  against. 

It  is  our  ol)ject  to  save  and  improve,  not  to  destroy. 
Extraction  should  only  be  resorted  to  when  it  appears,  after 
careful  consideration,  to  be  the  only  or  best  way  of  accom- 
plishing the  object  in  view.  Ill-advised  extraction  of  the 
molars  or  bicuspids  has  often  been  the  cause  of  a  very  serious 
and  irremedial)le  form  of  deformity,  namely : — the  separation 
of  the  anterior  teeth  from  one  another,  leaving  unsightly 
spaces  between  them,  thus  depriving  them  of  their  natural 
support  and  leading  to  their  earlier  loss. 

When  teeth,  especially  the  first  molars,  are  extracted  at  a 
later  period  than  they  sliould  l)e,  leaving  a  space  tliat  the 
second  molars  cannot  occupy,  the  teeth  anterior  to  tlie  space 
will  fall  back  unless  prevented  by  the  occlusion.  If  this 
falling  back  pertains  only  to  the  bicuspids,  no  harm  will 
usually  result,  but  if  it  extends  to  the  anterior  teeth,  as  it 
may  and  often  does,  the  result  will  be  disastrous.  In  this 
connection  we  cannot  help  again  ,em])hasizing  the  necessity 
for  the  removal  of  lirst  molars  (if  they  ai'e  to  be  removed) 
before  the  second  molars  have  assumed  their  })laces  in  the 
arch. 

//  a  crowded  arch  calls  for  or  will  ad  ml  f  of  expavm))!  to  advan- 
tage, da  this  in  preference  to  extracting. 


CHAPTER  Vlir. 

PHYSIOLOGY   (^F    TOOTH-MOVEMENT    AND    CHARACTER    OF 
TISSUES   INVOLVED. 

In  changing  the  position  of  teeth  in  the  act  of  regiihiting, 
the  ssuiTouiiding  tissue?!,  both  hai\l  and  soft,  ure  largely 
involved. 

In  order  therefore  to  properly  comprehend  the  pliilosophy 
of  tooth  movement,  it  is  necessary  to  understand  tlie  structu- 
ral character  of  these  tissues  and  the  physiological  changes 
that  take  place  in  them  while  a  tooth  is  ht'ing  moved. 

THE  ALVEOLAR  PROCESS. 

This  process,  as  its  name  implies,  is  not  a  separate  and 
distinct  bone,  but  an  outgrowth  from  another.  It  is  a,  pro- 
visional structure  designed  to  support  the  teeth  in  })()sition 
and  atl'ord  lodgement  for  the  nutrient  vessels  leading  to  them. 
It  is  formed  upon  the  body  of  the  bones  of  the  jaw  as  the 
teeth  are  developed,  growing  with  them  until  they  are  fully 
formed  and  then  remaining  while  they  remain. 

When  the  teeth  are  lost,  there  being  no  longer  any  special 
use  for  it,  most  of  tliis  process  is  absorbed  and  carried  away- 
In  early  infancy  little  alveolar  structure  exists,  but  it  is 
formed  co-ordinately  with  the  growth  of  the  deciduous  teeth 
and  remains  during  the  period  of  their  retention.  Should 
they  l)e  lost  before  their  successors  are  ready  to  appear,  the 
process  will  b(>  entirely  removed  1)V  abs()r})tion,  and  a  new 
one  be  formed  for  the  accommodation  of  the  permanent 
teeth.  Where,  however,  the  deciduous  teeth  are  gradually 
shed  to  make  way  for  their  successors,  the  process  is  not 
entirely  absorbed,  the  basal  and  unabsorbed  portion  serving 
as  a  foundation  upon  which  the  new  structure  is  formed. 

The  alveolar  process,  being  built  or  formed  upon  the  body 
of  the  maxillary  bones,  conforms  to  them  in  outline    and 

49 


50  ORTHODONTIA. 

describe;-  the  .same  curves.  In  depth  it  corres})oiids  to  the 
length  of  the  roots  of  the  teeth,  while  in  Avidtli  it  is  sufficient 
to  envelop  all  of  that  portion  of  the  teeth  located  below  the 
gum  line.  It  gradually  increases  in  width  as  it  approaches 
the  body  of  the  bone  upon  which  it  rests. 

It  consists  of  an  outer  and  inner  plate  united  at  intervals 
by  septa,  thus  forming  the  alveoli  for  the  accommodation  of 
the  roots  of  the  teeth.  In  structure,  the  process  is  not  com- 
pact, but  open  and  spongy,  .somewhat  resembling  the  can- 
cellated structure  of  the  diploe  of  the  bones  of  the  cranium 
or  the  inner  portion  of  the  shafts  of  the  long  bones.  Its 
outer  or  cortical  layer  is  denser  and  harder  than  the  inner 
portion.  Its  cellular  structure,  while  giving  it  sufficient  firm- 
ness to  .support  the  teeth  in  their  position.s,  affords  opportu- 
nity for  the  lodgement  and  passage  of  the  vessels  of  nutri- 
tion Avith  which  it  is  .so  bountifully  supplied. 

Owing  to  its  peculiar  .structure  and  its  great  vascularity, 
it  is  readily  resorbed  under  the  stimulus  of  pres.sure  and 
again  readily  re2:)roduced  behind  the  moving  teeth. 

THE   TEETH. 

Of  the  teeth  themselves,  liut  little  need  be  said.  The  stu- 
dent is  familiar  with  their  number,  .shape,  position  and 
structure.  Being  the  hardest  structures  of  the  human  Ijody, 
the  application  of  any  force  necessary  to  move  them  will  not 
injuriously  affect  them  so  far  as  their  hard  tissues  are  con- 
cerned. 

A  mechanical  difficulty  associated  with  their  moving  con- 
sists in  the  fact  that  their  crowns  are  round  and  smooth,  thus 
making  it  somewhat  difficult  to  apply  force  at  a  given  point. 
This  difficulty,  however,  has  been  overcome  by  the  intro- 
duction of  tlie  Magill  band. 

In  considering  the  moving  of  teeth,  the  fact  nui.-^t  not  be 
overlooked  that  while  the  crown  may  be  moved  considerably, 
the  movement  becomes  less  and  less  along  the  line  of  the 
root  so  that  tlie  apex  is  moved  but  little.     This  is  due  to  the 


PRTNCIPLES     INVOLVED.  51 

fact  that  force  can  only  be  applied  to  the  crown,  while  the 
apex  remains  almost  a  fixed  point  or  fulcrum.  In  the  move- 
ment of  a  tooth  therefore,  whether  inw'ard  or  outward,  for- 
ward or  backward,  the  crown  describes  the  arc  of  a  circle, 
the  centre  of  wdiich  is  near  the  apex  of  the  root. 

Teeth  with  single  and  short  roots  can  be  moved  more 
readily  than  those  with  long  and  many  roots,  for  the  reason 
that  in  the  former  case  there  will  be  less  resistance  to  be 
overcome. 

THE   PULP. 

The  pulp  is  the  formative  organ  of  the  tooth,  and  after 
calcification  is  complete  it  remains  as  the  principal  source  of 
nutrient  supply  for  the  dental  tissues,  especially  the  dentine. 

It  is  composed  of  fibrous  connective  tissue,  containing  a 
delicate  system  of  lymphatics,  together  with  numerous  nerve 
filaments  which  enter  through  the  apical  foramen.  Ramifi- 
cations of  minute  blood-vessels  are  noticeable  throughout 
its  whole  extent,  giving  color  to  the  organ  and  constituting 
its  vascular  system. 

It  bears  an  important  relation  to  the  teetli  in  their  move- 
ment since  it  may  be  readily  devitalized  through  impru- 
dence or  lack  of  care.  Before  calcification  of  the  teeth  has 
been  completed  the  apical  foramen  is  large  and  easily  accom- 
modates the  pulp  where  it  enters  the  tooth.  After  calcification 
is  complete  the  apical  foramen  is  small,  and  the  pulp  at  this 
j)oint  is  in  consequence  greatly  reduced  in  size.  In  the 
movement  of  the  teeth  there  is  often  a  slight  mechanical 
constriction  of  the  pulp  at  the  apex  due  to  the  tipping  of  the 
tooth  in  moving.  If  the  movement  be  rapid  in  teeth  fully 
calcified  (after  the  sixteenth  or  eighteenth  year)  this  constric- 
tion may  be  so  great  as  to  cause  the  death  of  tlie  pulp  through 
strangulation.  Before  complete  calcification  this  is  not  likely 
to  occur,  from  the  fact  that  when  the  foramen  is  large  the 
pulp  has  more  space  for  its  accommodation. 

In  the  movement  of  a  tooth  in  the  direction  of  its  length 
the  pulp  may   also   become  devitalized  through  excessive 


O'l  ORTHODONTIA. 

stretching.  This  has  occurred  at  times  in  (h'awing  down  into 
line  a  tooth  that  lias  been  retarded  in  eruption.  In  all  such 
cases  care  must  be  exercised  and  the  movement  be  conducted 
slowly. 

THE   PERICEMENTUM. 

The  pericementum  or  peridental  membrane  is  that  tissue 
which  envelops  the  root  of  the  tooth  and  tills  the  space 
intervening  l)etween  it  and  the  alveolar  wall.  It  is  a  tough, 
strong  membrane,  composed  mainly  of  fibrous  connective 
tissue,  permeated  with  blood  vessels  and  nerve  fibres  and 
containing  traces  of  a  lymphatic  system. 

It  is  stronglv  adherent  to  the  alveolar  wall  of  the  socket 
on  the  one  hand  and  to  the  cementum  of  the  tooth  on  the 
other,  its  adherence  being  due  to  the  extension  of  its  fibres 
into  both  the  bone  and  the  cementum.  These  fibres, 
according  to  Prof.  Black,*  "  are  wholly  of  the  white  or  inelastic 
connective  tissue  variety,"  and  the  apparent  elasticity  of  the 
membrane  is  due  to  tlie  passage  of  mo.st  of  the  fibres  from 
cementum  to  wall  in  an  oblique  direction,  in  such  a  way  as 
to  "swing  the  tooth  in  its  socket." 

This  membrane  is  the  formative  organ  of  the  cementum 
of  the  tooth  and  also  a.ssists  in  building  the  walls  of  the 
alveoli. 

The  cells  concerned  in  the  building  of  the  bony  walls  are 
known  as  osteoblasts,  and  those  forming  the  cementum  are 
designated  cementoblasts.  After  these  cells  have  performed 
their  normal  function,  they  become  encapsuhMl  an<l  form 
part  of  the  tissue  tlR\y  were  instrumental  in  l)uilding. 

When  re-formation  of  tissue  is  demanded,  as  in  the  thick- 
ening of  the  alveolar  wall,  or  in  enlarging  the  normal 
amount  of  cementum  at  various  points  under  certain  con- 
dition.s,  new  cells  are  originated  to  perform  the  work.  In 
the  moving  of  a  tooth  the  activity  of  these  new  cells  is  at 
once  manifested  in  the  formation  of  alveolar  tissue  to  fill  the 
space  caused  by  the  advancing  tooth. 

*Dental  Review,  vol.  I.,  p.  240. 


rKIXCIPLES     INVOLVED.  53 

Beside  these  cells  of  construction  and  repair,  the  perice- 
mentum also  contains  cells  that  might  well  be  called  cdl>i  of 
dcsfrudioii.  Thcv  are  the  osteoclasts  or  cementoclasts,  and 
tlicir  function  is  to  break  down  or  absorb  the  cemental  or 
osseous  tissues  when  nature  calls  for  sucli  action. 

In  tlie  correction  of  irrregularities,  these  cells  perform 
valual)le  service  in  removing  bt)ny  tissue  in  front  of  the 
moving  tooth. 

The  pericementum  is  thickest  in  eliildhood,  when  the 
sockets  or  alveoli  are  of  necessity  considerably  larger  than 
the  roots  of  the  teeth  which  they  contain.  With  advancing 
age  both  cementum  and  the  alveolar  walls  are  increased  in 
thickness  by  slow  but  continuous  growth  until  the  perice- 
mentum is  greatly  reduced  in  thickness,  and  in  consequence 
the  diameter  of  the  roots  more  nearly  approximates  that  of 
the  alveoli  or  sockets. 

The  pericementum  [possesses  a  variety  of  function  not  often 
met  with  in  any  single  tissue  of  the  human  system. 

It  retains  the  tooth  in  its  socket  and  acts  as  a  cushion  to 
prevent  injury  to  the  adjoining  bony  structures  from  hard 
and  violent  concussions  to  which  tlie  teeth  are  sometimes 
subjected. 

It  affords  accommodation  for  numerous  blood-vessels  which 
supply  both  the  teeth  and  alveolar  tissue  with  nutrient 
material,  and  for  the  branches  of  nerves  which  constitute  it 
the  sensory  organ  of  the  tooth,  so  ftir  as  tactual  impress  is 
concerned. 

It  is  the  organ  of  construction  and  repair  of  both  cemen- 
tum and  bone,  and  is  also,  on  occasion,  the  organ  of 
destruction  of  either  or  both  of  these  tissues. 

Its  great  importance  in  the  moving  of  teeth  is  shown  in 
the  fact  that  without  its  services  teeth  could  not  be  altered 
in  their  positions  without  serious  injury  to  themselves  or  ad- 
joining parts,  and  if  so  moved  would  be  useless,  because  they 
could  not  possibly  be  made  firm  in  their  new  positions.     In 


54  Oi;TH()n(')NTIA. 

other  words,  the  regulation  of  teeth  would  be  a  physical  im- 
])ossibility  without  the  important  services  rendered  by  this 
peridental  membrane. 

PHYSIOLOGICAL  ACTION   IN  THE  MOVEMENT  OF  A  TOOTH. 

When  force  is  exerted  u[)on  a  tooth  for  the  purpose  of 
niovino  it,  the  first  effect  produced  is  the  compression  of  the 
pericementum  between  the  tooth  and  alveolar  wall  on  the 
advancing  side,  and  the  stretching  of  the  same  membrane 
on  the  opposite  side.  In  the  compression  of  the  membrane, 
the  blood  supply  is  partly  cut  off  and  the  nerves,  by  their 
irritation,  create  a  sensation  of  pain,  which  is  soon  obliterated 
by  the  semi-paralysis  brought  about  by  continued  pressure. 
At  the  same  time  this  irritation  stimulates  and  hastens  the 
development  of  the  osteoclasts  which  at  once  begin  the  work 
of  breaking  down  and  absorbing  that  portion  of  the  socket 
pressed  upon. 

Bony  tissue  being  thus  removed,  accommodation  is  made 
for  the  advancement  of  the  tooth,  which  at  once  takes  place. 
Under  continued  pressure  this  action  is  renewed  again  and 
again  until  the  tooth  has  reached  its  intended  position.  While 
this  is  taking  place  on  the  advancing  side,  quite  an  opposite 
condition  prevails  on  the  side  from  which  advancement  has 
taken  place.  There  the  fibrous  tissue  of  the  pericementum 
has  been  subjected  to  extreme  tension ;  greater  room  has 
been  provided  for  the  accommodation  of  the  nutrient  vessels, 
and  osteoblasts  have  been  develo[)e(l  for  the  formation  of 
bony  material  to  add  to  the  alveolar  wall  and  thus  close  the 
space  caused  by  the  movement  of  the  tooth.  While  these 
processes  of  absorption  nnd  reproduction  on  opposite  sides 
of  the  tooth  have  been  going  on  coincidently,  their  results 
have  been  very  unequal,  for  the  absorption  of  bone  is  a  far 
more  rapid  [)rocess  than  its  formation. 

During  the  entire  time  of  nujving  and  for  a  long  time 
afterward,  the  tension  of  the  pericementum  on  the  free  side  of 
the  tooth  is  kei)t  up  to  such  an  extent  that  were  the  force 


rRiNciPLES   involvp:d.  55 

of  pressure  or  retention  removed,  tlie  tooth  would  at  once  be 
drawn  partly  ])ack  into  the  !S[)aee  created  b}^  its  movement. 

The  tendency  is  only  tinally  overcome  after  the  deposit  of 
ossific  matter  in  the  alveolar  socket  has  l)een  sufficient  to 
allow  the  pericementum  to  resume  its  normal  tliickness  on 
that  side  of  the  tooth,  when,  by  virtue  of  the  removal  of  the 
tension  and  the  supi)ort  of  the  new  bony  tissue,  the  backward 
movement  of  the  teeth  will  no  longer  be  possil)le. 

While  this  process  of  reparative  construction  has  been 
going  on,  the  structures  about  the  opposite  side  of  the  tooth 
have  been  adjusting  themselves  to  the  new  condition.  The 
pressure  upon  the  tooth  having  ceased,  no  more  bone  is  ab- 
sorbed ;  any  injury  inflicted  upon  the  pericementum  by  its 
continued  compression  is  repaired ;  the  nerves  and  blood- 
vessels resume  their  normal  functions  and  the  tooth  in  its 
new  position  becomes  a  far  more  useful  member  of  the  den- 
tal ora'anism  than  it  had  been. 


PART  II. 

CHAPTEE    I. 
MATERIALS   AND   METHODS. 

EXAMINATION  (JF  THE  MOUTH. 

AVhcii  a  case  of  irregularity  presents  lor  treatiiierit,  the 
first  requirement  is  a  careful  examination  of  the  mouth  and 
teeth. 

In  conducting  tins  examination  it  is  necessary  to  note  the 
position  of  the  teeth;  their  relation  to  one  another;  their 
occlusion  with  those  of  the  opposite  jaw ;  the  relative  size 
and  shape  of  both  arches ;  the  size,  character  and  condition 
of  the  teeth ;  the  age  and  general  health  of  the  patient ; 
the  harmony  or  inliarmony  of  the  features  and  the  facial 
expression. 

A  careful  consideration  of  all  tliese  points  will  enable  us 
to  decide : — 

1st.  AVhat  is  desiralde. 

2nd.  Whether  it  can  Ije  done. 

3rd.  If  possible,  how  it  can  best  be  aecoiii[)lished. 

After  this  preliminary  examination,  our  opinion  of  the 
case  should  be  given  the  patient  or  parent,  accomi)anied  by 
a  j)lain  statement  of  tlie  difficulties  of  the  case,  if  such  exist, 
the  probable  time  tliat  will  be  rc()uir(Ml  for  correction,  and 
an  a[)proximate  estimate  of  the  cost.  To  avoid  any  possible 
niisai)prehension,  tlic  patient  should   also  be  informed  that 

50 


MATKKIALS     AND     METHODS.  57 

the  appliances  will  cause  some  annoyance  and  possibly  some 
pain,  and  that  patience,  endurance  and  ])erseverance  will  be 
necessary  on  his  or  her  {)art  to  enable  us  to  accomplish  a 
satisfactory  result. 

It  should  also  be  mutually  understood  that  the  parent  or 
patient  shall  assist  in  the  furtherance  of  the  work  by  seeing 
that  the  appliances  are  faithfully  worn,  that  all  the  instruc- 
tions are  carried  out,  and  that  the  patient  shall  punctually 
meet  all  appointments  that  may  be  made. 

Should  the  prognosis  of  the  case  prove  satisfactory  and  all 
of  the  above  conditions  be  agreed  to,  we  may  at  once  proceed 
with  the  treatment. 

IMPRESSION  AND  ARTICULATION. 

The  first  step  will  be  to  take  impressions  of  the  upper  and 
lower  teeth,  from  which  to  secure  models  for  the  further  and 
more  exact  study  of  the  case. 

These  impressions  should  be  taken  with  some  material  that 
will  receive  a  sharp  imprint,  and  not  materially  change  its 
shape  in  removal  from  the  mouth.  Either  Plaster  of  Paris  or 
Modelling  Composition  (Stent's  or  Godiva)  will  give  satis- 
factory results,  but  as  the  former  can  only  be  removed  from 
the  mouth  by  being  broken  into  many  pieces  the  latter  is  gen- 
erally preferred.  In  selecting  the  impression  cups,  those 
known  as  fiat-bottom  cups  (Figs.  7  and  S)  should  be  chosen, 
on  account  of  the  better  accommodation  they  afford  for  the 
crowns  of  the  teeth.  The  cups  should  in  all  cases  be  large 
enough  to  allow  for  a  sufficient  quantity  of  the  material 
along  the  outer  rim  to  enable  a  perfect  impression  to  be 
taken  of  the  labial  and  buccal  surfaces  of  the  teeth,  and  as 
much  of  the  gum  above  them  as  possible. 

A  proper  quantity  of  the  composition  having  been  softened 
by  dry  heat  or  in  hot  water,  it  is  placed  and  properly  shaped 
in  the  previously  warmed  cup  and  rapidly  introduced  into 
the  mouth. 

In  taking  an  impression  of  the  upper  jaw  the  mouth 


58  oirrHODOXTiA. 

should  be  kej^t  well  open  so  tiiat  the  teeth  may  not  come  in 
contact  with  the  material  before  the  proper  time  and  thus  mar 
the  surface.     When  tlie  eu[)  with  its  contents  has  been  placed 
Fig.  7.  Fig.  8. 


Impression  Cups. 

as  far  back  as  necessar}^  and  immediately  beneath  the  teeth, 
it  should  be  brought  up  into  position  with  a  straight  and 
steady  movement.  Once  there,  it  should  be  firmly  held 
while  a  finger  is  introduced  to  force  forward  into  position 
that  portion  of  the  material  which  has  escaped  at  the  rear 
of  the  cup,  after  which  all  that  portion  along  the  outer  rim 
should  be  pressed  against  the  teeth  and  gums  from  molar 
to  molar. 

In  this  position  it  must  be  tirmly  held  until  it  has  become 
so  hard  that  a  finger  nail  will  scarcely  indent  it,  when  it 
should  be  carefully  removed.  The  hardening  is  best  hastened 
by  a  stream  of  cold  water  from  a  syringe,  or  by  the  renewed 
application  to  the  cup  of  small  .sponges  dipped  in  cold  water 
as  suggested  by  Prof.  Newkirk. 

In  taking  an  impression  of  the  lower  jaw,  the  same  gen- 
eral method  is  followed,  and  after  the  cup  is  well  in  place 
all  tlie  surplus  material  around  both  the  outer  and  inner 
rims  should  be  pressed  into  place  with  the  finger. 


MATERIALS     AND     METHODS. 


59 


The  models  obtained  from  impressions  taken  in  this  man- 
ner will  be  sufficiently  accurate  to  give  us  a  good  representa- 
tion of  both  the  buccal  and  lingual  surfaces  of  the  teeth,  so 
necessary  to  a  proper  study  of  the  case. 

Impressions  taken  in  plaster  are  the  most  accurate  in  detail, 
but  the  composition  gives  us  all  the  accuracy  we  need  in 
models  for  regulating. 

During  the  same  sitting  at  which  the  impressions  are 
taken,  the  manner  in  which  the  teeth  occlude  should  be 
observed  and  recorded,  so  as  to  enable  us  to  place  the  models 
in  proper  relation  while  being  attached  to  the  articulator. 
This  will  dispense  with  the  necessity  for  taking  a  bite. 

A 11     inex-  F^fj   9 

pensive  and 
excellent  ar- 
ticulator, Fig. 
i),  for  the 
mounting  of 
models  of  ir- 
regularity, is 
made  from 
brass  w  ire. 
The  upper 
arms  and  coil 
are  one  con- 
tinuous piece, 
while  the 
lower  arms 

are  formed  bv  "^'^^  Author's  wire  Arliculator. 

passing  another  piece  of  the  wire  through  the  coil  and  bend- 
ing to  shape. 

The  articulator  is  so  slender  in  outline  that  after  the  models 
are  attached  to  it  the  occlusion  of  the  inner  cusps  of  the 
teeth  may  be  as  readily  examined  as  that  of  the  outer  ones. 

With  the  models  properly  mounted  on  the  articulator,  our 
second  and  more  deliberate  study  of  the  case  may  be  carried 
forward  at  our  leisure. 


GO  ORTHODONTIA. 

At  the  first  or  personal  examination  of  the  case,  we  are 
supposed  to  have  decided  upon  the  advisability  of  an  attempt 
at  correction,  and  also  upon  the  general  plan  we  purpose 
pursuing.  By  the  study  of  the  articulated  models,  we  will  be 
enabled  to  decide  upon  the  details  of  the  work,  and  the  kind 
of  appliance  that  should  be  used.  Both  studies  are  necessary, 
for  witli  the  patient  in  the  cliair  we  cannot  take  the  time  to 
map  out  the  proposed  work  in  detail,  while  an  examination 
of  the  models  alone  will  leave  us  without  a  knowledge  of 
many  important  characteristics  of  the  ease  that  can  alone 
be  gained  from  a  personal  examination. 

STUDY  OF  CASE  FROM  ARTICULATED  MODELS. 

The  study  of  the  case  may  be  either  a  simple  or  difficult 
one,  according  to  the  conditions  and  requirements  involved. 
Thus,  the  movement  of  a  single  tooth  will  only  involve  the 
consideration  of  providing  accommodation  for  it  in  the  arch 
and  the  manner  of  applying  force  to  bring  it  into  position, 
whereas  when  a  number  of  teeth  in  different  locations  are 
to  be  moved,  each  perhaps  requiring  a  different  form  of 
movement,  we  will  have  to  decide  whether  we  can  and  should 
produce  all  of  these  movements  with  one  appliance  at  one 
time,  or  whether  it  would  be  best  to  produce  each  move- 
ment separately  and  possibly  with  dififerent  appliances.  If 
the  latter,  we  will  have  to  determine  which  should  be  accom- 
plished first,  which  next,  and  so  on. 

For  instance,  where  the  entire  upper  arch  is  to  be  expanded 
to  make  room  for  outstanding  cuspids,  we  will  have  three 
different  o])erations  toj^erform  ;  the  side  teeth  must  be  moved 
laterally,  the  anterior  ones  forward  and  the  cuspids  inward 
into  line.  To  produce  all  of  these  movements  at  the  same 
time  with  one  appliance,  would  be  impossible  from  the 
nature  of  the  case ;  therefore  they  will  have  to  be  performed 
separately,  and  usually  in  the  order  in  which  they  have  been 
named.  In  attemi)ting  to  produce  many  movements  with 
one  a])pliance,  we  often  defeat  our  object ;  although  occasion- 


MATERIAJ.S     AND     METHODS.  01 

ally,  whore  the  movements  to  be  i)r()(luce(l  are  of  opposite 
character,  we  may  advantageously  play  one  against  the  other. 

Where  they  are  of  the  same  character,  or  nearly  so,  too 
much  should  not  be  attempted  at  one  time,  for  the  loosen- 
ing of  many  teeth  will  be  liable  to  make  our  anchorage 
unstable,  in  which  case  we  would  have  to  suspend  all  opera- 
tions until  some  of  the  teeth  again  became  firm. 

Having  decided  upon  the  order  in  which  the  movements 
should  take  place,  we  have  two  other  imjjortant  points  to 
determine. 

Amoinif  of  power  required. — This  will  l)e  determined  largely 
by  the  age  of  the  patient  and  the  character  of  the  teeth  and 
process.  As  previously  stated,  at  an  early  age,  before  the 
process  has  become  fully  calcified,  the  teeth  can  be  moved 
more  rapidly  than  at  a  later  period,  and  less  power  will  be 
required  to  accomplish  it ;  so  also,  in  patients  of  the  same 
age,  the  teeth  of  one  will  be  more  readily  moved  than  those 
of  the  other.  This  is  due  both  to  the  relative  length  of  the 
roots  and  the  resistance  of  the  alveolar  walls,  and  as  we  can- 
not judge  of  the  lengths  of  the  roots  from  the  appearance 
of  the  crowns  alone,  we  have  to  form  our  opinion  in  the  mat- 
ter from  the  general  conditions. 

Observation  has  shown  that  teeth  with  large  crowns,  situ- 
ated in  large  and  firm  looking  jaws,  usually  have  long  roots  ; 
whereas,  smaller  teeth,  associated  with  thin  and  more  delicate 
j)rocesses,  have  shorter  roots. 

Therefore,  considering  the  age  of  the  patient  and  the  ap- 
pearance of  the  teeth  and  processes,  we  can  at  least  decide 
whether  the  amount  of  force  to  be  applied  should  be  great 
or  little. 

Manner  of  applying  power. — Among  the  many  appliances 
or  substances  for  yielding  power  in  the  moving  of  teeth,  the 
practitioner  has  a  range  of  choice  from  the  screw  with  its 
directness  and  power,  to  the  silk  ligature  with  its  gentle 
traction. 

Between  these  two  extremes  we  have  materials  that  will 


62  ORTHODONTIA. 

yield  us  force  of  any  desired  degree.  Selecting  the  one  which 
seems  best  suited  to  the  case,  we  must  next  decide  upon  the 
most  advantageous  manner  of  using  or  applying  it. 

There  are  two  general  methods  of  securing  the  power- 
producing  appliances  in  the  mouth.  One  is  the  use  of  a 
plate  of  some  kind  to  which  .attachments  can  be  made,  and 
the  other  is  the  plan  of  attaching  the  appliances  to  the 
natural  teeth  in  such  a  way  as  to  dispense  with  tlie  Avearing 
of  a  plate. 

In  certain  methods  of  regulating,  .such  as  Angle's  and 
Patrick's,  no  plate  is  used ;  while  in  others,  such  as 
Cothn's.  a  plate-  is  invariably  used  for  attachment  and 
security.  Farrar  advocates  the  use  of  a  plate  only  in  excep- 
tional cases.  Each  manner  has  its  advantages  and  disad- 
vantages.    In  the  use  of  a  plate,  we  have  as  advantages : — 

Its  convenience  and  adapt (ibiJity. — Covering  a  large  surface, 
it  affords  opportunity  for  the  attachment  of  the  immediate 
power-yielding  appliance  in  any  position  and  at  any  angle, 
and  permits  the  same  to  be  altered  or  changed  with  very 
little  trouble.  It  also  protects  the  soft  tissues  from  any  pos- 
sible injury  whicli  might  result  from  the  slijiping  or  impinge- 
ment of  other  appliances  upon  them.  Indeed,  in  many  cases, 
a  plain  rubber  plate  covering  the  roof  of  the  mouth  and  not 
having  any  appliances  attached  to  it,  is  used  simply  for  the 
protection  of  the  gums  during  the  operation  of  regulating. 

Its  distrlbntion  of  the  power  of  resistance. — Touching  all  or 
nearly  all  of  tlie  teeth  not  being  operated  upon,  it  compels 
each  one  to  bear  its  part  in  offering  resistance  to  the  power 
used  for  the  movement  of  certain  teeth,  and  in  this  way 
brings  more  teeth  into  use  as  points  of  resistance  than  can 
possibly  be  done  by  any  other  metliod. 

Its  sirnj/Iicity  of  constmction  and  tin  faciJitij  it  affords  for  ad- 
justment and  altered ioii. 

The  disadvantages  pertaining  to  the  employment  of  a 
plate  as  an  aid  in  regulating,  are : — 

Its  uncIeanU)iess. — Ina.smuch  as  a  plate  comes  in  contact 
with  so  much  tooth  .surface  at  the  necks  and  elsewhere,  it 


MATERIALS     AND     METHODS.  63 

offers  special  ()i)|)()rtunitv  for  the  aeciiniulatioii  of  deltris.  In 
plates  that  are  removable  by  the  ])atient,  this  may  be  largely 
avoided  by  frequent  eleansino-,  but  observation  has  shown 
that  the  majority  of  patients  are  either  so  careless  or  indif- 
ferent in  regard  to  the  matter,  that  a  clean  regulating  plate  is 
seldom  seen.  In  plates  so  constructed  or  arranged  that  only 
the  dentist  can  remove  them,  the  uncleanliness  of  the  plate 
is  greatly  increased. 

The  frequent  appoinfDients  iiecessary. — In  the  class  of  plates 
last  alluded  to,  it  is  absolutely  important  that  they  be  removed 
and  cleansed  at  least  once  in  every  forty-eight  hours.  This 
requires  such  frequent  visits  on  tlie  part  of.  the  patient  and 
the  expenditure  of  so  much  valuable  time  on  the  part  of  the 
operator,  as  to  constitute  a  great  objection  to  the  use  of  such 
plates  where  they  can  at  all  be  dispensed  with. 

Notwithstanding  these  disadvantages,  however,  the  employ- 
ment of  plates  is  necessary  in  many  cases. 

When  plates  are  not  used,  appliances  are  usually  attached 
directly  to  certain  teeth  which  serve  as  anchorages.  Such 
attachment  is  generally  secured  by  means  of  bands  or 
collars  encircling  the  teeth  and  cemented  to  them ;  or,  in 
other  cases,  by  having  the  bands  simply  passed  around  the 
teeth  of  attachment  and  drawn  tight  by  means  of  screws 
or  clamps. 

The  advantages  of  appliances  attached  to  the  teeth  in  this 
w^ay  are  : — 

1st.  The  leaving  of  the  roof  of  the  mouth  uncovered,  thus 
affording  more  room  for  the  movements  of  the  tongue. 

2nd.  Their  greater  cleanliness,  because  they  touch  the 
teeth  at  few  points,  and  thus  furnish  good  opportunity  for 
thorough  cleansing  with  the  brush. 

3rd.  Not  needing  to  be  removed  often,  fewer  visits  to  the 
dentist  are  necessary,  thus  effecting  a  great  saving  in  time 
and  labor. 

The  disadvantages  of  this  manner  of  attachment  are  : — 

1st.  The  few^er  teeth  that  are  brought  into  service  in  an- 
choring the  appliance.      In  any  sim})le  case  of  regulating 


64 


ORTHODONTIA. 


Fig.  10. 


this  objection  would  luive  but  little  weight,  for  the  amount 
of  resistance  needed  could  readily  be  obtained ;  but  in  com- 
plicated cases  there  would  be  great  likelihood  of  the  anchor- 
ages proving  insufficient  to  resist  tlie  great  force  brought  to 
bear  upon  them.  This  objection  may  be  largel,y  Overcome 
by  making  such  extensions  or  additions  to  a  band  as  to  cause 
teeth  adjoining  the  banded  ones  to  bear  their  part  in  offer- 
ing resistance.  Extensions  of  this  character,  as  used  in  the 
author's  practice,  may  be  seen  in  cuts  10  and  11. 

In  Fig.  10,  a  bicuspid  is 
banded,  and  to  the  band 
on  the  buccal  side  is  sold- 
ered a  strip  of  platinized 
ffold  lono-  enough  to  reach 
to  and  rest  upon  the  ad- 
joiningteeth,  causing  them 
to  bear  theii'  part  in  afford- 
ing the  needed  resistance. 
We  thus  get  the  resistance 
of  three  teeth  with  the  use 
of  a  single  band. 

In  Fig.  11,  an  extension 
strip  of  gold  is  soldered  to 
a  bicuspid  band,  in  order 
to  obtain  the  additional  re- 
sistance of  the  adjoining 
molar. 

Dr.  Angle  recommends 
tlie  banding  of  two  adjoin- 
ing teeth  and  having  these 
Itands  united  before  being 
l)laced  in  position.  He 
infieasc-.i  Anchoiage.  claiuis  that  by  tlus  mctliod 

the  resistance  is  greatly  increased,  for  the  anchor  teeth  to 
move  at  all  would  have  to  move  bodily  forward  in  an  up- 
right position  instead  of  ti})ping.     So  much  resistance  to  this 


Fig.  11. 


MATERIALS     AND     METHODS.  65 

form  of  movement  would  be  offered  by  the  mass  of  alveolar 
tissue  involved,  as  to  make  it  almost  impossible  of  accom- 
plishment. 

2nd.  The  injurious  effect  of  bands  upon  the  teeth.  When 
bands  are  placed  around  teeth  and  secured  by  some  mechan- 
ical device,  they  never  can  fit  tlie  teeth  so  accurately  as  to 
avoid  spaces  for  the  accumulation  of  food  and  saliva.  The 
fermentation  of  the  particles  of  food,  and  the  acidity  of  the 
saliva  in  a  state  of  rest,  will  soon  injuriously  affect  even 
good  tooth  structure. 

This  can  only  be  prevented  by  the  employment  of  some 
material  that  will  perfectly  fill  the  space  between  the  band 
and  the  tooth.  Exj^erience  has  abundantly  proven  that  all 
})ands  passing  around  and  encircling  the  teeth,  in  order  to 
be  harmless,  should  be  cemented  in  place  either  with  oxy- 
chloride  or  phosphate  of  zinc. 


CHAPTER  II. 
APPLIANCES. 

MATERIALS  AND  THEIR  USES. 

During  the  study  of  the  case,  after  we  have  decided  upon 

the  amount  and  kind  of  power  we  wish  to  apply  in  order  to 

produce  the  desired  movements,  we  will  have  to  consider  the 

different  materials  at  our  disposal  in  order  that  we  may 

select  from  them  the  ones  best  suited  to  our  purpose  for  the 

case  in  hand. 

PLATINUM  AND  ITS  ALLOYS. 

Platinum  on  account  of  its  tastelessness,  its  non-oxida- 
bility  and  its  harmonious  color,  should  constitute  it  one  of 
the  best  metals  for  use  in  the  mouth.  Its  extreme  plia- 
bility and  softness,  however,  greatly  limit  its  usefulness,  so 
that  it  can  be  used  only  where  these  latter  cjualities  do  not 
interfere  with  its  employment. 

It  is  chiefly  used  in  the  construction  of  bands  that  are  to 
be  cemented  to  the  teeth  to  serve  as  anchorage  for  appli- 
ances or  to  form  parts  of  retaining  fixtures. 

In  combination  with  other  metals,  in  the  form  of  alloys, 
its  greatest  usefulness  is  develoj^ed. 

IRIDIO-PLATINUM. 

This  alloy,  combining  the  color  and  purity  of  platinum 
with  the  hardness  and  stiffness  of  iridium,  is  useful  for  bands, 
bars  and  wires,  in  connection  with  regulating  appliances 
where  platinum  alone  would  not  be  available  on  account  of 
its  softness. 

PLATINIZED   GOLD. 

(Jold  in  ;i  pure  state,  oi-  alloyed  witli  silver  or  copjicr,  does 
not  possess  the  stifTiiess  necessary  j'or  its  use  in  the  form  of 

m 


MATERIALS     AND     METHODS.  67 

bars,  springs  or  accessories,  where  great  resistance  or  elas- 
ticity is  requisite,  but  when  alloyed  with  about  five  per  cent, 
of  platinum  it  attains  a  degree  of  elasticity  second  only  to 
steel.  In  tliis  form  it  is  one  of  our  most  useful  materials, 
for  even  the  heat  of  soldering  does  not  rob  it  of  its  elastic 
equality. 

This  alloy  of  gold  can  be  purchased  in  the  dental  de2:)ots 
in  plate  of  any  thickness  and  in  wire  of  any  form  or  size. 
When  used  for  the  construction  of  screws  or  supports,  its 
stiffness  is  the  quality  taken  advantage  of,  while  in  the 
form  of  levers  or  bows  its  elasticity  constitutes  its  chief 
excellence. 

PLATINIZED  SILVER. 

This  allov,  thouo-h  lono-  and  favorablv  known  in  Eno-land, 
has  never  been  extensively  used  in  America.  It  is  prepared 
for  the  market  in  tlie  form  of  plate  and  wire  of  every  gauge. 
In  the  form  of  })late  it  is  largely  used  abroad  as  a  l)ase  for 
artificial  dentures,  especially  small  partial  pieces,  while  the 
wire  is  used  as  a  support  for  the  Ash  tube-teeth  and  other 
j)urposes. 

The  alloy  is  composed  of  one  part  of  platiniun  to  two  of 
silver.  Its  stiflthess  and  elasticity  is  but  little  inferior  to 
platinized  gold,  while  its  cost  is  less  than  one-third  that  of 
gold.  It  can  be  rolled,  bent  or  fashioned  in  any  form  and 
may  l)e  soldered  with  the  highest  grades  of  gold  solder. 

In  the  form  of  wire  the  author  has  found  it  very  useful 
in  the  construction  of  bows  for  the  attachment  of  rubber 
bands  or  ligatures  to  draw  teeth  in  any  direction,  and  for 
parts  of  retaining  appliances  where  inconspicuousness  is 
desirable. 

Its  non-oxidability  is  also  a  feature  of  considerable  value. 

GERMAN  SILVER. 

This  improperly  named  alloy,  composed  of  copper,  zinc 
and  nickel,  is  frequently  employed  by  some  practitioners  in 
the  construction  of  regulating  appliances,  on  account  of  its 


68  ORTHODOXTIA. 

stiffness  and  inexpensiveness.  While  it  may  be  regarded  as 
a  base  compound,  its  baseness  is  of  so  high  a  grade  that  it 
may  be  used  ^vithout  fear  of  harm  to  the  soft  tissues  or  the 
general  system.  Prof  Angle  uses  it  almost  exclusively  in 
the  construction  of  his  appliances,  and  the  author  has  made 
frequent  use  of  it  without  ever  noticing  any  detrimental 
effects.  Its  valuable  qualities  are  too  many  for  us  to  deprive 
ourselves  of 

GOLD. 

Gold,  in  its  non-elastic  condition,  has  been  and  probably 
always  will  be  one  of  the  most  useful  of  the  metals  for  the 
construction  of  parts  of  regulating  appliances.  Its  softness? 
adaptability  and  strength  are  all  qualities  of  the  greatest 
value  and  render  it  serviceable  in  numberless  ways.  To  pre- 
serve its  purity,  and  as  far  as  possible  to  prevent  oxidation, 
it  should  never  be  used  of  a  carat  less  than  20  or  22. 

STEEL. 

This  metal  has  the  same  desirable  qualities  of  firmness 
and  elasticity  that  are  found  in  platinized  gold,  and  possesses 
them  in  a  higher  degree,  so  that  it  is  used  in  preference  to 
the  former  metal  where  greater  power  is  needed. 

There  are  two  disadvantages,  however,  connected  with  its 
u.se : — one  is,  that  it  cannot  be  highl}-  heated  (as  in  solder- 
ing) without  losing  its  temper ;  and  the  other,  that  it  oxidizes 
so  readily  when  in  contact  with  the  fluids  of  the  mouth.  But 
for  these  drawbacks  it  would  be  employed  more  frequently 
in  connection  with  regulating  appliances.  It  is  used  prin- 
cipally in  the  construction  of  jack-,  and  other  screws,  and  as 
wire  in  the  form  of  bows,  levers  and  springs. 

In  tlie  latter  form  its  use  Avas  first  brought  prominently 
before  the  profession  by  Mr.  Coffln,  of  England,  in  connec- 
tion with  his  method  of  regulation. 

VULCANITE. 

Soon  after  tlie  introduction  of  vulcanite  as  a  base  for  arti- 
ficial teeth,  its  qualities  of  adaptability,  strength  and  elas- 


^rx\.TERIALS     AND     METHODS.  (30 

ticity  were  recognized  and  utilized  in  the  construction  of 
appliances  for  regulating.  By  its  use  we  secure  advantages 
that  could  neither  be  so  readily  nor  so  well  gained  by  any 
other  known  substance. 

Used  either  to  produce  pressure  by  its  own  elasticity,  or  as 
a  medium  for  the  attachment  of  other  power-producing  appli- 
ances, its  value  cannot  well  be  over-estimated.  It  has  been 
and  is  now  one  of  the  most  commonly  employed  materials 
for  the  construction  of  regulating  appliances.  Some  of  the 
many  ways  in  which  it  so  admirably  serves  us  are  shown  in 
Part  III. 

COMPRESSED  WOOD. 

The  use  of  this  substance  is  very  old.  Before  the  intro- 
duction of  either  soft  or  vulcanized  rubber,  the  quality  of  the 
expansion  of  compressed  wood  under  moisture  was  employed 
in  lieu  of  elasticity. 

It  was  chiefly  used  in  the  form  of  small  sections  placed 
between  a  silver  or  gold  plate  and  the  teeth  to  be  moved,  a 
suitable  slot  or  socket  for  its  retention  having  been  formed 
in  the  plate. 

In  this  way  it  is  no  longer  used,  other  materials  possessing 
superior  qualities  having  superceded  it. 

The  author  occasionally  finds  great  advantage  from  the 
use  of  compressed  wood  in  the  separation  of  teeth  for  the 
accommodation  of  some  malposed  tooth,  where  the  existing 
space,  though  not  sufficient,  is  still  too  great  to  admit  of  the 
use  of  elastic  rubber. 

In  such  case  it  is  his  custom  to  cut  a  cross-section  from 
some  compressible  wood,  such  as  cotton- wood,  a  little  larger 
than  the  space  it  is  to  occupy.  This  is  compressed  in  the 
direction  of  the  length  of  tlie  fibre  by  means  of  a  hammer, 
after  which  it  is  notched  at  each  end  to  fit  the  convex  sur- 
faces of  the  teeth  to  be  moved.  Upon  being  placed  in 
position  its  expansion  by  the  absorption  of  the  fluids  of  the 
mouth  will  quickly  cause  the  movement  of  the  teeth.  In 
the  course  of  its  expansion  it  adapts  itself  accurately  to  the 


70  OETHODOXTIA. 

tooth  surfaces  and  thus  does  not  become  dislodged  or  sUp 
from  its  position. 

SEA-TAXGLE. 

This  is  one  of  the  newer  substances  introduced  into  the 
list  of  materials  that  are  of  service  in  regulating.  The  idea 
of  its  use  was  borrowed  from  the  medical  fraternity,  who 
first  employed  it  for  distention  of  the  cervex  uteri.  It  is  a 
variety  of  sea-weed  roljbed  of  its  moisture  and  comj^ressed 
until  its  density  is  about  equal  to  that  of  horn.  For  medi- 
cal use  it  comes  in  the  form  of  a  cylindrical  tent  about  one- 
fourth  of  an  inch  in  thickness  and  two  inches  in  length. 

This  is  the  only  form  in  which  it  has  been  placed  upon  the 
market.  In  the  presence  of  moisture  it  rapidly  expands 
from  two  to  three  diameters.  As  it  expands  only  in  the 
direction  of  its  width,  sections  from  it  must  be  so  cut  and 
shaped  as  to  take  advantage  of  this  lateral  enlargement. 

In  regulating  it  may  be  employed  in  place  of  compressed 
wood,  and  like  it  is  used  to  produce  i^ressure  between  the 
unyielding  plate  and  the  tooth  to  be  moved.  A  place  for  it 
is  readily  provided  by  cutting  a  hole  or  socket  in  the  rubber 
plate  at  the  desired  point. 

Its  advantage  over  rubber  or  Avood  lies  in  its  greater  ex- 
pansive properties  and  the  ease  with  which  it  can  be  secured 
in  place.  A  piece  of  suitable  size  can  be  placed  in  position, 
and  the  plate  properly  secured  in  the  mouth  before  exjDan- 

sion  begins. 

ELASTIC  EUBBEE. 

The  resilience  of  elastic  rubber  was  early  recognized  as  a 
valuable  property  that  might  be  used  to  advantage  in  pro- 
ducing traction  upon  teeth  to  be  moved.  It  was  first  used 
in  the  form  of  strips  attached  at  either  end  by  ligature,  but 
since  the  introduction  of  rubber  tubing,  rings  or  bands  cut 
from  the  .same  have  been  employed  instead.  Their  fir.st  em- 
ployment has  been  credited  to  Dr.  E.  G.  Tucker,  of  Boston, 
about  the  vear  1846. 


MATERIALS     AND     METHODS.  71 

These  sections,  cut  from  the  smaller  sizes  of  French  rubber 
tubing,  are  now  in  almost  universal  use  in  connection  with 
other  appliances  for  regulating,  and  their  value  has  been 
greatly  enhanced  since  the  Magill  band  has  furnished  a 
better  means  for  their  attachment. 

Their  power,  though  great,  is  limited,  for  they  cannot 
exert  so  great  a  force  as  the  metals ;  but  their  wide  range  of 
applicability  and  the  persistence  of  their  power  [)laces  them 
among  the  most  valual)le  adjuncts  of  regulating  devices. 

In  use,  their  tendency  to  slip  off  the  tooth  or  up  under  the 
gum  (which  constitutes  the  chief  objection  to  their  employ- 
ment) must  be  guarded  against  by  so  securing  them  that 
change  of  position  will  be  impossible.  They  should  never 
be  permitted  to  rest  upon  or  touch  the  soft  tissues  at  any 
point. 

SILK  LIGATURES. 

The  contraction  of  silk,  linen  or  cotton  thread  in  contact 
with  moisture,  enables  us  to  make  use  of  it  where  the 
gentlest  tractile  power  is  desired.  Most  frequently  it  is 
employed  simply  as  a  ligature  in  attaching  some  appliance 
to  the  teeth ;  but  it  has  often  been  used  to  advantage  in  cases 
where  teeth  were  to  be  moved  slowly  and  a  very  short  dis- 
tance. Prof.  Peirce  employs  it  in  this  way  for  the  moving  of 
certain  single-rooted  teeth,  as  described  in  Part  III.  Its 
gentle  power,  together  with  its  safety  and  simplicity,  will 
often  prove  the  very  qualities  we  desire  in  certain  simple 
operations. 


72  ORTHODONTIA. 


QUALITIES  AN  APPLIANCE  SHOULD  POSSESS. 

In  selecting  a  form  of  appliance  from  among  the  many 
that  have  been  devised  by  writers  and  workers  in  this  field 
of  practice,  or  in  devising  one  to  suit  the  demands  of  the 
case  under  consideration,  it  will  be  well  to  consider  and  bear 
in  mind  the  (jualities  any  appliance  should  possess  in  order 
to  render  it  most  effective. 

The  following  are  among  the  most  important  of  such 
qualities : — 

Efficiency. — The  first  requirement  of  any  device  is,  that  it 
shall  be  able  to  do  the  work  expected  of  it.  All  appliances 
are,  of  course,  devised  with  this  end  in  view,  but  the  attain- 
ment of  it  is  often  not  as  simple  a  matter  as  might  at  first 
appear.  Almost  every  case  has  associated  with  it  so  many 
features  and  peculiarities  claiming  consideration,  that  even 
with  the  greatest  care  and  thought  we  often  fail  to  apprehend 
or  grasp  each  individual  complication.  Some,  indeed,  are 
so  little  apparent  that  they  can  scarcely  be  recognized  in 
advance. 

For  this  reason  even  the  most  experienced  practitioners 
will  at  times  devise  an  appliance  which,  though  seemingly 
meeting  all  the  requirements,  will,  when  brought  to  a  practi- 
cal test,  fail  to  accomplish  the  end  desired.  It  will  then  have 
to  be  altered,  or  perhaps  discarded,  in  favor  of  some  other 
fixture  more  perfectly  adapted  to  the  requirements  of  the 
case. 

An  appliance  that  will  not  yield  the  results  we  desire,  or 
whicli  yields  them  in  an  imperfect  manner,  should  in  all 
cases  be  su[)erseded  by  another. 

Sim]>licltij. — A  c(Miiphcated  device  is  in  nearly  all  cases  less 
cfiiciciit  than  a  Hiin])k'  one.     Simplicity  is  a  cardinal  virtue 


MATERIALS     AND     METHODS.  73 

in  all  matters  of  construction,  and  through  lack  of  it  about 
seventy-five  per  cent,  of  the  patents  granted  in  this  country 
prove  unprofitable. 

Far  greater  mechanical  ingenuity  is  displayed  in  an  effec- 
tive simple  device  than  in  a  complicated  one. 

Bapidity  of  action. — In  order  to  lessen  the  discomfort  of  the 
patient,  and  to  conserve  the  time  of  both  patient  and  oper- 
ator, a  regulating  appliance  should  be  as  rapid  in  its  action 
as  is  consistent  with  physiological  conditions.  Too  rapid 
action  may  cause  suffering  to  the  patient,  and  possibly  bring- 
about  deleterious  results ;  while  too  slow  action  will  prolong 
the  treatment  unnecessarily,  and  possibly  cause  the  patient 
to  become  disheartened  and  abandon  the  treatment. 

Between  these  two  extremes  there  is  a  mean  in  which  the 
best  results  are  accomplished. 

All  regulating  appliances  are  at  best  a  source  of  some  dis- 
comfort to  the  patient.  A  foreign  body  in  the  mouth,  occupy- 
ing a  certain  amount  of  space  and  thereby  interfering  more 
or  less  with  natural  functions,  cannot  fail  to  be  objectionable. 
In  order,  therefore,  to  lessen  this  discomfort  as  much  as  pos- 
sible, we  should  try  to  devise  appliances  that  will  occupy  no 
more  space  than  is  necessary,  and  also  have  them  free  from 
all  rough  projections.  Very  little  is  required  to  cause  abra- 
sion of  or  injury  to  the  soft  tissues  of  the  oral  cavity,  and 
when  once  caused  such  lesions  are  the  source  of  much  pain. 

Least  interference  with  speech  and  mastication. — Most  patients 
apply  to  us  for  correction  of  irregularity  at  a  time  when  their 
education  is  in  progress.  Their  lessons  must  be  recited,  and 
their  enunciation  must  be  distinct  enough  to  be  understood 
by  the  teacher.  With  a  large  and  cumbersome  appliance  in 
the  mouth  it  would  prove  very  difficult  for  them  to  speak 
distinctly,  and  they  would  thus  be  placed  at  a  disadvantage. 

They  are  also  in  their  growing  age  when  the  body  needs 
an  abundance  of  nutritious  food  to  supply  the  demands  of 
the  various  tissues.  If  mastication  be  insufficient  through 
imperfect  occlusion  or  through  tenderness  of  the  teeth  caused 


74  OKTHODONTIA. 

by  a  bulky  fixture,  nutrition  will  be  inadequate  to  the  needs 
of  the  system. 

Such  conditions  can  and  ou(;lit  to  be  avoided  by  a 
properh'  constructed  appHance. 

Clecnilincsfi. — The  cleanliness  of  any  appliance  will  depend 
both  upon  tlie  method  of  its  construction  and  the  care  that 
is  taken  of  it.  If  it  be  removable  so  that  the  patient  can 
take  it  out,  cleanse  and  reinsert  it,  there  ought  to  be  no 
difficulty  aljout  its  being  kept  clean.  The  patient  should  be 
instructed  to  remove  it  for  cleansing  at  night,  in  the 
morning,  and  after  each  meal,  at  the  same  time  giving  the 
natural  teeth  a  thorough  brushing. 

A  good  plan  is  to  supply  the  patient  Avitli  a  brush,  prop- 
erly marked,  to  be  kept  in  the  office.  When  the  j^atient 
appears  and  the  appliance  is  removed,  the  operator  shovild 
see  that  ])oth  plate  and  teeth  are  well  cleansed  in  his  pre- 
sence. This  one  cleansing  he  will  1  )e  sure  of,  though  he  may 
not  be  certain  of  the  others.  The  same  plan  is  pursued  with 
plates  or  appliances  that  can  only  be  removed  l)y  tlie  oper- 
ator. Where  appliances  are  of  such  character  that  they 
seldom  need  to  be  disturbed,  the  patient  should  be  taught  to 
take  a  quantity  of  water  in  the  mouth,  and  then  using  tlie 
lips  and  cheeks  bellows-fashion,  force  the  water  through  every 
interstice  of  the. teeth  and  appliance  to  flush  out  accumula- 
tions. This  should  l)e  done  each  time  after  eating,  as  well  as 
before  retiring  and  after  rising. 

Most  appliances  can  be  worn  a  long  time  without  injure- 
to  tooth  suljstance,  if  they  are  properly  constructed  and  kept 
scrnjndously  clean. 

Without  cleanliness,  the  teetli  will  soon  be  injured  by  the 
secretions  and  accumulations,  and  the  Ijreath  of  the  patient, 
from  the  same  cause,  will  become  so  offensive  as  to  disgust 
all  brought  within  its  range. 

Iiicoii^picnoviiiK-fiH. — Annoyance  from  wearing  a  conspicu- 
ous appliance  is  often  added  to  the  other  ills  which  the 
patient  is  subjected  to  diuiiig  the  process  of  regulation.     An 


MATERIALS     AND     METHODS.  75 

appliance  of  this  character,  wliile  often  producing  distortion 
of  the  lips,  also  attracts  much  attention  and  compels  the 
wearer  to  make  frequent  answer  to  the  same  oft-repeated 
question. 

Young  persons  attending  school,  or  entering  societ}',  are 
naturally  very  sensitive  to  the  ill-appearance  of  any  conspic- 
uous device.  Whenever  the  same  result  can  be  accomplished 
by  a  concealed  fixture  as  by  an  exposed  one,  it  is  better  to 
adopt  the  former ;  but  where  a  better  or  more  satisfactory 
result  can  be  obtained  by  the  use  of  a  more  prominent 
fixture,  appearance  will,  of  course,  have  to  be  sul>ordinated 
to  utility. 

Stabilifi/. — The  (juality  of  stability  has  previously  been 
spoken  of,  but  its  real  practical  importance  cannot  be  too 
strongly  insisted  upon.  It  is  a  sine  qua  nan  in  orthodontic 
practice.  With  it,  we  have  a  reasonable  certainty  of  results  ; 
without  it,  all  is  uncertainty. 

In  some  cases,  as  where  most  or  all  of  the  superior  teeth 
are  to  be  drawn  backward,  we  have  apparently  no  point  for 
proper  anchorage.  Stability  or  fixedness  of  position  for  an 
appliance,  in  such  cases,  not  being  obtainable  within  the 
mouth,  some  fixture  can  be  devised  which  will  have  its  point 
of  resistance  outside,  as  on  the  back  of  the  head. 

This  plan  of  securing  resistance  outside  of  the  mouth, 
has  been  adopted  thus  far  only  in  a  few  exceptional  cases, 
but  it  is  hoped  that  its  advantages  and  importance  will  lead 
to  its  more  frequent  employment  in  the  future. 

Freedom  from  injury  to  tooth  ^nhdance. — By  this  we  do  not 
mean  chemical  injury,  for  that  has  already  been  treated  of, 
but  we  refer  to  mechanical  injury.  Any  sharp,  hard  })oint 
or  roughness  of  a  metallic  appliance,  will  be  likely  to  scratch 
and  mar  the  surftice  of  enamel  and  thus  prepare  the  way  for 
future  decay. 

Steel  jack-screws  of  any  form,  when  placed  directly  against 
the  teeth  of  anchorage  and  those  to  be  moved,  are  liable  to 
work  injury  to  tooth  structure.    For  this  reason  there  should 


76  ORTHODONTIA. 

always  be  interposed  between  the  teeth  and  screw  some 
material  that  is  non-injurious  to  the  tooth.  Besides  protect- 
ing the  teeth,  such  substance  will  also  serve  to  give  greater 
security  to  the  screw. 

To  obtain  this  same  fixedness  for  the  point  of  a  fish-tail 
jack-screw,  or  other  appliance,  some  operators  have  been 
in  the  habit  of  drilling  a  hole  or  depression  in  the  tooth  to 
be  moved.  It  is  hoped  that  the  introduction  of  the  Magill 
band  has  caused  the  abandonment  of  this  practice,  which  at 
best  was  only  justifiable  in  exceptional  cases  and  in  self- 
cleansing  localities. 


MATKIJIALS     AND     METHODS.  77 


RETAINING  APPLIANCES. 

Tlie  retention  in  situ  of  teeth  that  have  been  moved,  for  a 
time  sufficiently  long  to  allow  them  to  become  firm,  is  quite 
as  im})ovtant  as  the  moving  of  them.  As  previously  explained, 
teeth  become  firm  in  their  new  jtosition  by  virtue  of  a  deposit 
of  ossific  matter  in  the  space  created  by  their  displacement. 
The  formation  and  })erfect  ossification  of  this  new  material, 
is  only  completed  after  a  lapse  of  time  varying  with  the  age 
and  constitution  of  the  individual.  Experience  has  proven 
that  a  less  time  than  six  months  should  never  be  allowed 
for  it,  while  in  persons  of  mature  age  or  in  those  younger 
where  many  teeth  have  been  involved,  the  time  will  some- 
times have  to  be  extended  to  a  year  or  longer. 

The  natural  tendency  of  a  tooth  to  return  to  its  former 
position,  aided  l)y  the  tension  of  the  parts  that  have  resisted 
its  movement,  will  certainly  move  a  tooth  from  its  new 
position,  unless  the  newly  formed  process  has  become 
thoroughly  calcified,  and  is  thus  by  its  strength  and  density 
able  to  resist  the  opposing  forces.  Numberless  failures  to 
retain  the  good  results  of  regulation  are  attributable  to  this 
cause  alone. 

In  certain  cases,  as  where  a  superior  incisor  has  been 
occluding  inside  of  the  lower  ones,  or  where  a  lower  one  has 
been  biting  outside  of  the  upper  ones,  no  retaining  appliance 
will  be  required  after  they  have  been  brought  into  proper 
position,  because  the  natural  occlusion  of  the  jaws  will 
prevent  the  corrected  tooth  from  returning  to  its  former 
position. 

So  also  with  the  bicuspids  and  molars.  Where  mal- 
occlusion has  forced  them  out  of  their  true  position,  or  kept 
them  there,  the  correction  of  the  occlusion  will  often  tend  to 
retain  them  in  their  normal  positions  without  extraneous  aid. 

In  all  other  cases,  however,  mechanical  assistance  will  be 
necessary  until  the  teeth  have  become  firm.    AVhere  the  arch 


78 


ORTHODONTIA. 


or  any  portion  of  it  has  ])een  enlarged,  or  where  a  number 
of  teetli  have  been  moved  from  within  outward,  the  simplest 
and  probal)ly  the  best  means  of  retaining  them  will  be  the 
wearing  of  a  thin  rubber  plate  covering  the  palatal  arch 
and  nicely  fitting  each  tooth  at  its  neck.  It  may  contain  a 
vacuum-chamber  or  not,  as  preferred,  but  in  many  cases  the 
use  of  one  will  greatly  assist  in  keeping  the  plate  in  })lace. 
In  addition  to  its  use  in  preventing  teeth  from  moving- 
inward,  tlie  plate  may  often  be  advantageously  modified  by 
the  addition  of  a  gold  hook  or  spur  to  kee})  rotated  teeth  in 
position,  or  to  retain  individual  teeth  that  have  been  moved 
inward. 

In  cases  where  it  is  necessary  to  retain  a  number  of  teeth 
that  had  formerly  occupied  positions  outside  of  the  arch,  or 
where  some  had  stood  outside  and  some  inside,  probably  no 
plan  yet  devised  equals  in  simplicity  and  efficiency  the  one 
suggested  many  years  ago  by  Dr.  Richardson.  The  accom- 
panying illustration 
^^^-  ^~-  (Fig.  12)  represents  its 

general  appearance. 
It  consists  of  two 
narrow  strips  of  vul- 
canized rul)]3er  aljout 
one-fourth  of  an  inch 
in  Avidtli,  the  one 
fitting  tlie  gum  and 
necks  of  teetli  on  the 
palatine  surface,  and 
the  other  the  same 
portioiis  of  the  l)uccal  or  ]al)ial  surftice.  Tlie  two  are  either 
continuous  around  tlie  last  niolai-s,  or  tliey  are  separate  there 
and  joined  at  two  otlier  points  by  pieces  of  fiattened  gold 
wire  vulcanized  into  them.  These  wires  can  be  placed  at 
points  where  a  tooth  is  missing  or  where  space  exists  between 
the  teeth  ;  or,  if  the  articulation  of  the  teeth  be  not  too  close, 
they  can  be  passed  over  the  depressions  between  crowns  on 


Richardson's    Retainer. 


MATERIALS     AXD     METHODS. 


79 


the  masticating  surface.     The  appliance  is  light,  occupies 
little  s})ace  in  the  mouth,  and  is  not  very  noticeahlc. 

While  ruhher  plates  in  some  form,  either  hy  themselves  or 
in  combination  with  accessories,  are  the  most  commonly 
approved  appliances  for  retaining  corrected  teeth,  their  use 
is,  nevertheless,  open  to  certain  objections.  All  ruljber  plates 
used  either  for  correction  or  retention,  must  he  removed  at 
frequent  intervals  for  cleansing.  The  very  necessity  for  their 
removal  affords  opportunity  for  the  patient  to  remove  them 
at  other  times,  and  possibly  forget  or  willfully  neglect  to 
reinsert  them  for  a  longer  or  shorter  period,  thus  causing 
delay  in  the  reparative  process. 

Besides  this,  also,  in  the  very  act  of  removal  and  insertion 
the  teeth  are  slightly  moved  in  their  sockets,  and  this  will 
to  a  certain  dey-ree  hinder  the  re-formation  of  tissue. 

On  account  of  these  objectionable  features  the  author 
has  for  many  years  avoided  the  use  of  rubber  retaining 
plates,  wherever  he  could  do  without  them.  As  a  substitute 
he  was  led  to  devise  a  number  of  little  appliances  of  gold 
and  platinum,  occupying  the  least  possible  space,  and  firmly 
attached  to  the  teeth 
for  the  required  time. 
Fig.  13  shows  one  of 
these  appliances  in  its 
simplest  form.  It  con- 
sists of  a  platinum 
(Magill)  band,  freely 
fitted  to  the  tooth ,  and 
having  a  gold  bar  or 
spur  soldered  to  it  to 
press  or  bear  against 
one  or  more  of  the 
adjoining     teeth. 

When  properly  adjusted,  it  is  secured  to  the  corrected  tooth 
by  means  of  phosphate  of  zinc. 

As  will  readily  be  seen,  its  advantages  consist  in  its  small 


Fig.  13. 


The  Author's  Band  and  Bar  Retainer. 


80 


ORTTIODOXTIA. 


Fig.   14. 


Retainer. 


Fk;.   1.5 


Ketuiuer. 


size,  its  .slight  contact  witli  teeth  other  tlian  the  one  upon 
which  it  i.s  i)hice(l,its  cleanliness,  its  fixedness,  and  the  firm- 
ne.ss  with  which  it  liolds  the  corrected  tooth  in  plaee. 

The  latter  is  its  most  ini})ortant  feature,  for  it  is  a  well  recog- 
nized fact  in  surgical  practice  that,  other  things  being  equal, 
reunion  of  bony  tissue  or  new  formation  of  the  same  will 
progress  in  rapidity  proportionate  to  the  stability  of  the  parts. 
Fig.  14  shows  a  modification  where  two 
teeth  are  thus  to  be  retained,  with  the  exten- 
sion bar  long  enough  to  include  more  dis- 
tant teeth.  Fig.  15  represents  two  bands 
joined  at  their  borders,  for  the  retention  of 
two  teeth  tliat  have  been  rotated. 

Still  another  modification  is  shown  in  Fig. 
in.     In  this  case  the  two  bands  on  the  cus- 
]»ids  are  united  by  a  thin  gold  or  })latinum 
wire  passing  along  and  conforming  in  the 
Fk;.  in.  outline  to  the  labial  sur- 

faces of  the  intervening 
teeth.  It  was  used  to  re- 
tain tliree  incisor  teeth 
that  had  been  drawn  in- 
ward. 

Retaining  appliances  of 
this  character  cannot,  of 
course,  be  used  to  advan- 
tage in  all  cases ;  but  Avhere 
they  can  they  will  be 
found  to  1)0  most  satisfactory. 

Prof  Angle  uses  a  retaining  appli- 
ance differing  from  the  foregoing  in 
having  a  tube  soldered  horizontally 
to  the  band  that  encircles  the  tooth. 
The  tooth  once  in  position  a  wire  is 
passed  through  the  tube  and  made  to  restu])on  the  adjoin- 
ing teeth,  after  Avhich  a  hole  is  drilled  through  both  tube 


Band  and  Wire  Retainer. 

Fk;.  17. 


Angle's  Retainer. 


MATERIALS     AND     METHODS. 


81 


Fig.  Ifi. 


Tal 


Fig.  19. 


and  wire  and  a  short  pin  inserted  to  prevent  the;  wire  from 
shifting  its  position.  See  Fig.  17.  Dr.  Talhot  uses  an 
appliance  closely  resembling  that  of  Prof.  Angle.  See 
Fig.  18. 

Another  simple  and  ingen- 
ious device  for  retaining  teeth 
after  they  have  been  moved, 
especially  after  rotation,  was 
shown  the  author  by  Dr.  H.  L.  /-^^ 
Baker.  It  consists  of  a  gold 
screw  cemented  into  some  con- 
veniently located 
cavity  in  sucli  a 
way  that  the  pro- 
truding portion 
shall  rest  against 
an  adjoining 
tooth,  and  tiius 
prevent  the  tooth 
o  p  e  r  a  t  c  d  u  }>  o  n 
from  changing  its 
new  1^  o  s  i  t  i  o  n . 
Such  device  could, 
of  course,  only  be 
used  in  rare  and 
exceptional  cases ;  but  where  ap})licable,  it  possesses  the 
advantages  of  simplicity,  inconspicuousness  and  efficiency. 
Fig.  19  represents  a  case  in  which  a  rotated  incisor  was  thus 
retained. 


Baker's  IJatainer. 


CHAPTER  III. 
CONSIDERATION   OF   METHODS. 

FAERAR'S  METHOD. 

In  1876  Dr.  J.  N.  Farrar  began  publishing  a  series  of 
articles  in  the  Dental  Cosmos,  descriptive  of  a  method  he  had 
devised  for  the  regulation  of  teeth.  Reading  and  observa- 
tion, lie  said,  had  satisfied  him  that  the  various  plans 
suggested  up  to  that  time  for  the  correction  of  irregularity, 
"vvere  lacking  both  in  system  and  principle.  He  claimed  that 
the  performance  of  so  important  an  operation  as  regulation 
should  be  based  upon  a  correct  knowledge  of  Ijoth  mechan- 
ical and  i:)hysiological  law. 

Experience  had  convinced  hiin  that  the  character  of  force 
a})])lied  to  the  teeth  sliould  l)e  positive,  and  that  it  should  be 
intermittent — a  })eriod  of  rest  following  a  period  of  motion. 

The  best  instrument  for  applying  a  force  that  is  positive 
and  may  be  intermittent,  he  stiid,  was  the  screw  in  one  of  its 
various  forms. 

Experimenting  with  appliances  constructed  u])on  the  screw 
principle,  convinced  him  that  this  method  of  delivering 
force  was  not  only  positive  and  direct,  but  also  that  its  range 
of  applicability  was  so  great  that  it  might  be  used  to  the  best 
advantage  in  nearly  all  cases  of  regulating.  He  claimed, 
also,  lliat  it  was  tlie  only  instrument  wliose  force  could  be 
controlled  at  will,  and  thus  be  made  to  exert  power  u])on  or 
retain  in  a  state  of  re])0se  the  tooth  or  teeth  operated  upon. 

This  alteniiilion  of  motion  and  rest  in  changing  the  posi- 
ti<Mi  of  tcctli,  was  as  important  as  in  other  organs  of  the 
b(j<iy,  and  was  in  strict  accord  with  physiological  law.  In 
his  experiments  he  found  that  intermittent  force  was  pro- 

(82) 


MATERIALS     A.XI)     MrCTiroDS.  83 

ductiveof  less  i^ain  to  the  i)ati('iit  tliaii  coiitimious  forco,  and 
might  be  so  skilfully  a})plied  as  to  prevent  all  i)aiii. 

Pain,  he  said,  was  an  expression  of  a  patholooieal  eondi- 
tion,  and  l)v  its  avoidance  we  kept  within  the  boundary 
separating  the  physiological  from  the  pathological  state. 
With  screws  of  known  pitch  and  nundjer  of  threads,  he 
found  that  he  could  move  a  tooth  painlessly,  and  therefore 
safely,  from  2fi7  to  Y^o^  of  an  inch  every  tweidy-four  hours. 
His  experiments  led  him  to  the  following  conclusions  : — * 

"  Id.  That  in  regulating  teeth,  the  traction  must  be  inter- 
mittent, and  nuist  not  exceed  certain  fixed  limits. 

"  2nd.  That  while  the  system  of  moving  teeth  l)y  elastic 
rubber  apparatus  is  unscientific,  leads  to  ])ain  and  inflamma- 
tion, and  is  dangerous  to  the  future  usefulness  of  the  teeth 
operated  ui)on,  a  properly  constructed  metallic  ap})aratus, 
operated  by  screws  and  nuts,  produces  happy  results,  without 
pain  or  nervous  exhaustion. 

"  Srd.  That  if  teeth  are  moved  through  the  gums  and 
alveolar  ])rocess  about  -ji^  of  an  inch  every  morning,  and 
the  same  in  the  evening,  no  \)\\\n  or  nervous  exhaustion 
follows. 

"4-fli.  That  while  these  tissues  will  allow  an  advancement 
of  a  tooth  at  this  rate  (2!^  of  an  inch),  twice  in  twenty-four 
hours,  the  changes  being  ])hysiological,  yet,  if  a  nnich 
greater  pressure  be  made,  the  tissue  changes  will  l)ecome 
pathological." 

The  above  conclusions  were  epitomized  by  him  into  the 
following  Law: — "In  regulating  teeth,  the  dividing  line 
between  the  [)roduction  of  physiological  and  ])athological 
changes  in  the  tissues  of  the  jaw  is  found  to  lie  within  a 
movement  of  the  teeth  acted  u})on,  allowing  a  variation  which 
will  cover  all  cases,  not  exceeding  o-iir  or  y-^-jj  of  an  inch  every 
twelve  hours." 

A  full  elaboration  of  his  theories,  together  with  a  descrip- 

*  Dental  Cosmos,  Vol.  XVIII,  p.  23. 


84  oirriioDoNTiA. 

tion  of  methods,  illustrated  by  engravings  of  numerous 
appliances  devised  by  him,  may  be  found  in  the  Doifal  Cos- 
onos,  extending  from  Vol.  XVTII  to  XXR". 

Although  tlie  screw  princi}>le  Avas  the  one  wliieh  he  ])rin- 
cipally  used,  and  the  only  one  which  he  considered  scientifi- 
cally and  pliysiologically  correct,  he  at  times  availed  himself 
of  the  use  of  some  of  the  continuous-force  a|)pliances,  such 
as  rubber  bands,*  silk  or  fibre  ligatures,t  and  for  the 
attachment  of  appliances,  vulcanite  plates.| 

So  far  as  the  principles  upon  Avhich  Dr.  Farrar's  system  is 
based  are  concerned,  tliev  have  received  but  limited  public 
approval  on  the  part  of  the  profession ;  but  the  multiplicity 
and  variety  of  his  appliances  and  the  ingenuity  displayed 
in  their  devising,  have  commanded  the  admiration  of  all 
and  been  of  great  value  to  lal)orers  in  this  field.  Most  of  his 
appliances  are  original  in  design,  Ijeautiful  in  construction, 
and  well  calculated  to  perform  the  work  intended  ;  l)ut  in 
confining  himself  so  largely  to  the  use  of  one  form  of  power- 
producing  instrument,  his  apparatus  is  in  many  cases  very 
elaborate  and  complicated.  The  same  end  could  often  be 
accomplished  by  much  simpler  means. 

Dr.  Farrar's  appliances  are  so  numerous  that  illustrations 
of  all  of  them  could  not  l)e  introduced  into  a  text  book,  nor 
could  they  well  be  selected  fi-om  to  illustrate  his  ])rinciples, 
but  some  of  them  may  be  found  in  Fart  III,  wliere  the  prac- 
tical treatment  of  various  forms  of  irregularity  is  considered. 

PATRICK ',S    METHOD. 

In  FS82,  Dr.  Fatrick  brought  forward  his  method  of  regu- 
lating. His  appliance  is  made  of  gold,  and  designed  to  be 
attached  directly  to  the  teeth  on  presentation  of  patient, 
without  the  usual  jireliminaries  of  taking  an  impression  and 
makiuii'  a  model. 


*  Co»mo8,  Vol.  XIX,  p.  520. 
t       "  "     XXI,  "  306. 

t       "  "      XXI,  "  305. 


MATERIALS     AND     METHODS. 


85 


Fig.  20. 


The  appliance  with  its  appurtenances,  all  beautifully  con- 
structed and  ready  for  use,  may  be  purchased  from  the 
inventor  or  through  the  dental  depots. 

The  essential  parts  consist  of  a  bow-spring,  adjustable 
anchor  bands,  and  numerous  devices  for  engaging  with  the 
teeth  to  be  moved. 
Fig.  20  represents 
the  appliance  with 
many  of  the  acces- 
sories in  position. 
The  bow-spring 
"A"  consists  of  a 
half-round  bar  or 
wire  of  platinized 
gold,  bent  in  horse- 
shoe    form    to    ap-  Patrick's  Regulating  Appliance. 

proximately  conform  to  the  shape  of  the  arch.  "BB"  are 
the  adjustable  loop-bands,  made  of  thin  gold  plate,  the  free 
ends  of  which,  on  their  palatine  surfaces,  are  connected  with 
a  screw  and  fixed  nut  (C),  for  bringing  the  band  in  close 
contact  with  the  tooth  to  which  it  is  applied.  On  the  buccal 
surfaces  of  these  bands  are  soldered  sections  of  half-round 
tubing,  accurately  fitting  the  bow-spring  which  plays  through 
them.  Outside  of  this  tubing  is  soldered  a  nut  threaded  to 
receive  the  long  buccal  screw  (D)  intended  to  tighten  the  bow 
spring  after  it  is  in  position,  or  to  take  up  the  slack  caused 
by  the  moving  teeth.  The  head  of  this  screw  passes  through 
and  operates  against  a  smooth  nut  soldered  to  a  section  of  the 
tubing  which  is  temporarily  attached  to  the  bow-spring  at 
any  point  by  means  of  an  adjustable  double  wedge. 

Of  the  accessory  appliances  shown, "  E  "  is  a  hook  intended 
to  rest  against  the  mesial  or  distal  (by  reversing)  surfaces  of 
a  tooth  intended  to  be  moved  in  an  anterior  or  posterior 
direction.  It  is  secured  in  the  desired  position  by  a  wedge 
placed  between  the  inner  flat  surface  of  the  spring  and  the 
adjoining  surface  of  the  slide  to  which  the  hook  is  attached. 


86  ORTHODONTIA. 

The  tooth  is  moved  anteriorly  or  posteriorly  by  loosening 
the  Iniccal  screw  on  one  side  and  tiohtening  it  on  the  other 
toward  wliieli  the  tooth  is  intended  to  be  moved.  "  F"  is  a 
liook  to  catch  over  the  cuttinp;  edges  of  incisors,  when  it  is 
desired  to  move  them  from  within  outward.  When  in  posi- 
tion the  tension  of  the  bow-spring  is  increased  from  time  to 
time,  by  unscrewing  the  buccal  screws.  "  H  "  is  a  slide,  or 
section  of  the  half-round  tubing,  reinforced  on  its  palatine 
surface  by  additional  gold,  and  intended  to  be  used  as  a  stud 
to  prevent  one  portion  of  the  tooth  from  moving  while  the 
opposite  one  is  being  moved,  as  in  rotating  an  incisor.  It  is 
also  used  to  press  against  any  tooth  as  a  wedge  in  moving 
it  inward. 

"  G  "  is  a  T-bar  for  producing  double  rotation  of  the  inci- 
sors. "I  "  is  a  hook  set  vertically  to  engage  with  the  cutting 
edge  of  ail  incisor,  to  prevent  the  bow-spring  from  slipping 
up  toward  the  gum. 

"  J  "  is  a  Infurcated  hook,  to  grasp  a  cuspid  tootli  intended 
to  be  moved  outM'ard. 

Each  of  these  appurtenances  is  soldered  to  a  section  of  the 
half-round  tubing,  which  allows  it  to  be  moved  to  any  desired 
position  on  the  bow-spring.  Wlien  in  position,  they  are 
retained  Ijy  means  of  the  wedge  already  referred  to. 

xVs  will  readily  be  seen,  the  power  obtained  by  this  appli- 
ance consists  partly  in  the  elasticity  of  tlie  bow-spring  and 
partly  in  the  direct  action  of  the  tightening  screws. 

The  ingenuity  displayed  in  the  devising  of  this  method  is 
certainly  very  great,  and  the  delicacy  and  accuracy  of  con- 
struction of  the  various  parts  all  that  could  be  desired.  The 
combination  of  the  principles  of  the  spring  and  screw  bring 
into  play  two  of  the  most  important  ])owers  available  in 
regulation,  and  tlicii-  correlation  in  tliis  method  is  very 
hapjtily  ])rought  al)out. 

Like  all  other  methods,  however,  a  few  objections  stand  in 
the  way  of  its  Ix'ing  as  ])erfect  as  we  could  desire: — 

1.     All  uiicenicnicd    bands  ])lac('(l  ai'ound  teeth  and  kept 


ISfATERIALS     AND     METHOD!=?. 


87 


there  for  considerable  time,  are  likely  to  work  injury  to  the 
underlying  tooth  substance,  unless  the  tooth-structure  be  of 
the  densest  variety.  Cementing  the  bands  to  the  teeth,  accord- 
ing to  the  Magill  method,  will  obviate  this  trouble  and  attach 
the  bands  to  the  teeth  more  firmly. 

2.  Dr.  Patrick  usually  attaches  a  single  band  to  a  tooth 
on  each  side  of  tlie  mouth  to  obtain  resistance.  When 
several  teeth  are  firmly  implanted  in  front  of  the  banded 
teeth,  they  all  add  to  the  resisting  power ;  but  where  there 
are  none,  or  only  one  in  front  of  them,  the  resisting  power 
would  seem  to  be  too  slight  to  move  several  teeth  at  once. 
Where  two  adjoining  teeth  are  available  for  banding,  it  would 
be  better  to  band  both  of  them,  and  thus  add  to  the  stability 
of  the  anchorage. 

3.  The  conspicuousness  of  the  gold  bar  and  its  append- 
ages, is  another  objection.  Where  exposure  of  gold  or  other 
materials  cannot  well  l)e  avoided,  it  becomes  a  minor  con- 
sideration; but  where  it  can  be  obviated,  without  impair- 
ing the  efficiency  of  the  appliance,  it  certainly  should  be. 
Dr.  Patrick  has  also  devised  two  additional  ap})lianees  for 
moving  individual  teeth,  where  the  irregularity  is  confined 
to  one  side  of  the  arch,  and  where  the  bow-spring  would 
b  e  unnecessarily  conspicuous 
and  cumbersome.  In  these  cases 
the  power  is  obtained  from  the 
direct  action  of  the  screw  alone. 

Fig.  21  represents  the  device 
for  moving  a  bicuspid  either 
forward  or  l)ackward  in  the 
arch;  while  Fig.  22  illustrates 
the  same  appliance  modified 
for  use  in  drawing  a  cuspid  backward. 


Fig.   21 


Patrick' 


Modification  for  Cuspids  and 
Bicuspids. 


BYENES'  METHOD. 


Dr.  B.  S.  Byrnes  has  devised  a  method  for  regulating  teeth 
by  the  use  of  narrow  strips  of  fine  gold  variously  shaped  and 
bent  to  produce   tension   upon   the  malposed  teeth.     The 


88  ORTHODONTIA. 

method  is  an  exceedingly  novel  and  ingenious  one,  and  while 
it  could  not  be  used  to  advantage  in  all  cases,  still  contains 
elements  of  merit  that  will  be  of  value  to  the  practitioner. 
His  power  is  derived  from  the  elasticity  of  the  metal,  which 
is  corrugated  in  such  a  manner  as  to  develop  this  quality  in 
the  highest  degree.   . 

His  bands  are  made  Irom  gold  plate  of  20  to  22  k.  fine- 
ness, rolled  very  thin,  and  when  greater  power  is  needed  the 
bands  are  doubled  in  thickness.  He  uses  no  plates,  but 
anchors  liis  appliances  by  means  of  bands  to  suitable  teeth, 
^situated  at  some  distance  from  the  ones  to  be  moved. 

*  The  method  of  application,  in  a  general  way,  is  as  fol- 
lows.:— The  fixed  points  having  been  determined  upon,  the 
tooth  or  teeth  to  be  regulated  are  connected  with  them  by 
means  of  a  thin  gold  band.  The  band  is  manipulated 
so  as  to  form  it  into  a  spring,  or  series  of  springs,  so  adjusted 
as  to  bear  most  powerfully  on  the  misplaced  tooth.  Thus, 
supposing  that  a  projecting  superior  central  incisor  is  to  be 
drawn  inward  to  align  properly  with  the  remainder  of  the 
teeth  in  the  arch,  a  continuous  gold  band  embracing  the 
first  molars  on  both  sides  is  fitted  around  the  outside  of  the 
arch. 

With  a  dull  pointed  instrument,  like  a  burnisher,  the 
ribbon  is  then  pressed  into  the  interstices  of  the  teeth 
over  which  it  passes,  thus  forming  it  into  a  series  of  small 
springs.  The  incisor  being  the  most  prominent  point  will 
naturally  1)e  most  attected  by  the  pressure  exerted  by  the 
springs,  and  in  a  short  time  it  will  be  found  to  have  moved 
away  from  the  band,  so  that  it  is  no  longer  affected  by  its 
tension.  As  soon  as  this  occurs  the  apparatus  is  removed, 
the  ribbon  annealed  and  straightened,  and  a  small  portion, 
say  a  thirty-second  to  a  sixteenth  of  an  inch,  as  may  be 
required,  is  cut  out  of  it.  The  ends  are  then  soldered  and 
the  appliance  replaced  upon  the  teeth,  the  connecting  band 
being  formed  into  a  spring  as  before.     Tension  is  thus  kept 

*  Dental  Cosmos,  Vol.  XXVIII,  pp.  278-284. 


MATKlilALS     AND     METHODS. 


80 


Up  until  the  tootli  has  assuiiu'd  tlic  dcsirt'd  i)()siti()ii.  Some- 
times the  spring  of  the  l)au<l  may  be  advantageously  siii)ple- 
mented  by  other  aids,  as  the  insertion  of  a  rubber  wedge 
(under  the  band)  at  points  were  a  partieular  gain  is  desired. 


Fid. 


Figs.  23. 24  and -J.")  illus- 
trate the  general  api)ear- 
anoe  of  the  applianee  in 
some  of  its  forms. 

Figs.  23  and  24  were  used 
to  draw  in  })rojecting  in- 
cisors in  the  ease  of  a 
young  lady,  aged  18.  The 
movement  was  assisted  by 
rubber  wedges  placed  be- 
tween the  band  and  the 
labial  surfaces  of  the  teeth. 
"  The  connecting  band  was 
cut  and  shortened  every 
other  day,  the  patient 
having  a  sitting  every  day 
to  allow  the  band  to  be 
sprung  more  as  the  teeth 
moved  away  from  it." 

Fig.  25  represents  the 
form  of  appliance  used  by 
Dr.  Byrnes  in  drawing  for- 
ward    the     lower    incisors,  Byrnes' Band  Regulators. 

and  pressing  back  the  cuspids  at  the  same  time.  The 
band  clasped  the  first  molars  of  each  side  and  passed  around 
the  cuspids  and  back  of  the  incisors.  By  cutting  and  shorten- 
ing the  l:)and  from  time  to  time  as  the  teeth  yielded  to  the 
j)ressure,  the  irregularity  was  easily  and  quickly  corrected. 
Fig.  26  shows  the  form  of  a  corrugated  band  used  to  draw' 
inward  an  outstanding  central  incisor  in  the  up})er  jaw.  Two 
teeth  are  here  used  as  anchorages,  being  connected  by  a 
sinole  continuous  band. 


90 


ORTHODOXTIA. 


Fig.   27  sliows  a  more  complicated   apparatus  tliau  any 
of  those  i)revioiisly  described.      It  was  used  in  a  case  where 
Fi(i.  2n.  a  riglit  central  over- 

lapped the  lateral. 
It  illustrates  how  the 
method  may  be  ap- 
plied to  turn  a  tooth 
where  the  force  must 
l)e  applied  directly 
across  the  mouth. 

After  the  necessary 

room  was   provided;, 

this  fixture  was  aj)- 

'ied.       It   accom- 

])lished    its    work  in 

four  days,  after  which 

device    was 

c o n s i s t i n p-    of    a 


Byrnes'  Corrugated  Baad. 


Fig 


retaining 


Appliance  for  Rotation 


a 

used, 

simple  band  clasped 
tightly  around  the  central 
which  had  been  rotated, 
and  provided  with  wings 
ti})ping  on  the  left  central 
and  under  the  right 
ateral. 


THE  MAGILL  BAND. 

This  device,  while  not  ])roperly  constituting  a  method,  is 
considered  here,  because  through  its  great  value  it  has  come 
to  be  an  important  factor  in  several  methods  of  regulating- 
devised  since  its  introduction.  Dr.  W.  E.  Magill,  having  in 
common  with  other  practitioners  experienced  the  difficulty 
of  attaching  regulating  appliances  to  the  natural  teeth  in 
such  a  Avay  that  they  would  have  a  firm  hold  and  not  slip, 
devised  the  following  }dan  of  meeting  and  overcoming  the 
difficult  v.— 


MATERIALS     AND     METHODS.  91 

From  a  piece  of  ])latiiuini  plate.  X(».  2S.  Anieriean  .uaiige 
in  thiekiiess.  he  cut  a  strip  about  a  line  in  width,  and  bend- 
it  to  conform  to  the  s]iai)e  of  the  tooth,  soldered  it  at  the 
point  where  the  ends  overlapped,  thus  convertino-  it  into  a 
band  or  collar.  After  attacliing  to  this  band  any  studs,  pins 
or  hooks  tliat  the  case  demanded,  it  was  lined  with  oxy- 
chloride  of  zinc  and  slipped  over  the  dried  tooth  to  a  point 
about  midway  between  the  cutting-  edge  and  neck. 

Since  the  introduction  of  phosphate  of  zinc,  it  has  been 
found  to  be  a  far  better  medium  for  the  attachment  of  the 
band  to  the  tooth  than  the  oxy-chloride  of  zinc-,  formerly 
used.  Once  in  position,  the  cement  will  harden  in  about 
five  minutes,  after  which  no  ordinary  force  will  be  able  to 
dislodge  it.  If  a  wire  spring  is  intended  to  rest  again.'^t  and 
press  upon  a  banded  tooth,  a  hole  or  pit  should  be  drilled  in 
the  band  at  a  suitable  point,  before  it  is  cemented  in  place. 
If  rubber  bands  or  ligatures  are  to  be  employed,  suitable 
provision  for  their  easy  attachment  may  l)e  made  by  pre- 
A'iously  soldering  to  the  band  a  small  gold  hook,  or  a  headed 
platinum  pin  taken  from  a  vulcanite  tooth.  Where  a  jack- 
screw  is  to  be  used  in  the  moving  of  a  tooth,  an  abutment 
of  platinum  should  be  soldered  to  the  band  encircling  the 
resisting  tooth,  and  then  be  slotted  to  receive  one  end  of  the 
screw.  The  band  of  the  tooth  to  be  moved  should  also 
be  re-enforced  and  drilled  to  accommodate  the  point  of  the 
screw. 

When  the  operation  is  completed,  or  for  any  cause  it  may 
be  desirable  to  remove  the  band,  it  is  easily  accomplished 
by  protecting  the  enamel  at  the  cutting  edge  of  the  tooth 
with  a  folded  napkin  or  piece  of  chamois  skin,  and  placing 
one  beak  of  a  pair  of  pliers  upon  it  and  the  other  upon  the 
upper  edge  of  the  band,  the  closure  of  the  hand  will  dis- 
lodge the  appliance  without  in  the  least  marring  or  altering 
its  form.  By  this  simple  invention,  one  of  the  greatest  diffi- 
culties hitherto  experienced  in  regulating  has  been  overcome, 
and  its  devising  has  almost  introduced  a  new  era  in  regu- 


92  ORTHODONTIA. 

luting.  For  tlio  purpose  intended,  there  is  nothing  that- 
jipproaclies  it  in  etiieiency. 

Before  its  introduction,  attachment  to  tlie  tootli  to  be 
moved  was  usually  eflfected  hy  means  of  a  ligature  ingeni- 
ously a]>})lied  and  made  fast  by  some  form  of  knot,  or  a  pit 
or  hole  was  tlrilled  into  the  substance  of  tlie  tooth  to  receive 
the  point  of  a  scre^v  or  other  device  and  prevent  it  from. 
sli})ping.  The  knots  would  often  sli}),  and  the  drilling  of 
l)its  was  ol:)jectionable,  so  that  the  difficulties  of  securement 
Averc  not  overcome  until  the  invention  of  this  band. 

By  its  use  al)solutely  secure  attachment  and  anchorage  are 
obtained,  and  the  moving  of  teeth  is  accom|)lished  with  far 
greater  exactness  than  had  previously  been  possil)le.  When 
attachment  was  made  by  ligature,  it  was  often  necessary 
that  the  ligature  should  encircle  the  tooth  at  its  neck,  and 
when  not  necessary  to  place  it  there  it  would  often  slip  into 
that  position,  ow^ng  to  the  shape  of  the  tooth.  The  irrita- 
tion of  the  soft  tissues  thus  produced,  was  frequently  the 
cause  of  much  pain  to  the  patient.  The  Magill  band  obviates 
this  by  preventing  any  fixtures  attached  to  it  from  coming- 
in  contact  with  the  delicate  and  sensitive  mucous  membrane 
of  the  gum. 

Indeed,  the  author  has  found  that  by  its  use  nearly  all  the 
pain  of  regulating  has  been  done  away  with,  for  the  pain 
attendant  upon  regulating  by  the  old  methods,  was  caused 
not  so  much  by  the  slight  irritation  induced  by  the  moving- 
tooth,  as  by  the  impingement  of  ligatures,  rubber  bands  and 
other  appliances  upon  the  soft  tissues.  The  Magill  band  may 
therefore,  we  think,  be  credited  with  having  done  more  to 
modify  the  pain  accompanying  regulation  than  any  other 
device  ever  introduced. 

In  some  methods  of  regulating,  such  as  Farrar's  and  Pat- 
rick's, attachment  is  made  to  the  teeth  by  means  of  an  open 
band  of  gold,  secured  to  the  teeth  l)y  a  nut  and  bolt  operat- 
ing u})on  the  free  ends  of  the  band.  Such  device,  while 
valuable,  is  more  complicated,  cumbersome  and  less  cleanly 


MATEKIALS     AND     METHODS.  \l.j 

tliaii  tlic  Mau'ill  l)an(l.  It  is  also  opL'ii  to  the  objection  pre- 
viously noted,  that  of  allowing  the  secretions  to  remain 
between  the  tooth  and  l)and. 

Several  of  the  autlior's  methods  of  modifying  the  form  of 
tlie  band  by  means  of  attachments  to  increase  its  usefulness, 
will  be  illustrated  hi  Part  III. 

ANGLE'S  METHOD. 

This  method  of  regulating  was  first  brought  to  the  notice 
of  the  profession  by  its  originator,  Prof.  Edward  H.  Angle, 
in  a  paper  read  before  the  dental  section  of  the  Ninth  Inter- 
national Medical  Congress,  held  at  Washington,  D.  C,  Sep- 
tember, 1887. 

The  appliances  used  in  this  method  are  composed  entirely 
of  metal.  Power  is  obtained  by  the  well  known  mechanical 
forces  of  the  screw  and  lever,  the  latter  always  being  made 
of  piano  wire,  in  order  to  obtain  the  greatest  amount  of 
po^v■er. 

Support  of  the  appliances  or  resistance,  is  gained  by  firmly 
attaching  the  parts  to  the  teeth  by  the  Magill  band,  which 
is  always  cemented  in  place. 

The  appliances  are  few  in  number,  simple  in  design,  and 
easily  applied  ;  qualities  that  add  materially  to  the  value  of 
any  device  for  general  use.  Prof.  Angle,  in  describing  his 
method,  says: — 

"  Fig.  28  shows  the  simple  appliances  from  which  all  the 
various  combinations  used  in  the  method  may  be  made. 
''A"  is  a  large  traction  screw  encased  in  its  accompanying 
tube,  and  used  for  pulling  where  the  resistance  is  great. 
"  B"  is  a  smaller  traction  screw,  used  in  the  same  way  where 
the  resistance  is  slight,  or  where  from  any  reason  a  delicate 
appliance  is  desired.  "  C "  and  "  D "  are  tubes  which  are 
soldered  to  bands  placed  upon  the  teeth  to  be  moved,  into 
which  the  ends  of  the  traction  screws  are  hooked.  "J"  is  a 
jack-screw,  used  for  pushing,  the  end  of  which  is  beaten  flat. 
"  E  "  is  an  extra  piece  of  tubing,  by  means  of  which  a  longer 


94 


ORTHODOXTIA. 


jack-screw  can  be  made.     "  FF"  are  coils  of  l)and  material. 
"G"  is  a  gold  wire  ased  in  retaining,  and  "RR"  are  small 


Fig.  28. 


Angle's  Appliances. 

retaining  tubes  designed  to  be  soldered  to  bands,  into  which 
the  retaining  wire  accurately  fits.  "LL"  are  piano  wire 
levers  of  varying  sizes,  giving  different  degrees  of  power. 

"Aside  from  the  advantages  of  simplicity,  efficiency  and 
cleanliness,  which  are  insured  b}^  these  appliances,  a  still 
greater  desideratum  is  gained  by  means  of  the  mechanical 
principles  observed  in  their  construction.  Stationary  anchor- 
age and  non-relinquishment  of  pressure  are  prominent 
features  of  this  method,  and  are  certainly  secured  almost  to 
perfection. 

"  The  means  by  wliich  one  or  more  teeth  are  held  perfectly 

Fjq  29.  stationary,     while    serving     as     an 

anchorage   or  l)ase  of  resistance  for 

the   application    of    force    is    quite 

simj)le,  and  peculiar  to  this  method. 

"  One  or  more  teeth  are  banded, 

V,    as  shown  in  Fig.  29.      Soldered    to 

•^      the  bands  is  a  tube  of  some  length. 

Through    this    tube   a    rigid    shaft, 

threaded  at  one  end  and  bent  to  a  right  angle  at  the  other,  is 


MATERIALS     AND     METHODS. 


95 


Fk;.  ;?(). 


passed  to  a  tooth  to  l^e  moved.  On  turning  the  nut  the 
natural  tendency  would  be  to  tip  the  anchor  teeth  forward  in 
their  sockets ;  but  they  cannot  tip  thus,  l)ecause  of  their  rigid 
connection,  and  the  length  of  tube  surrounding  the  shaft. 
It  is  evident  that  two  teeth  thus  connected  cannot  move, 
except  as  they  move  together.  The  apices  of  the  roots 
must  move  the  same  distance  as  the  crowns,  if  any  move- 
ment at  all  occurs,  and  this  is  well  nigh  impossibl(\  The 
tooth  to  be  moved  is  connected 
with  the  shaft  in  such  manner 
that  it  may  tip,  and  responds 
l^y  moving  according  to  the 
force  applied.  The  dotted  lines 
of  the  diagram  show  the  direc- 
tion of  any  movement  that  oc- 
curs. Fig.  30  shows  the  same 
where  the  motion  is  pushing 
instead  of  pulling. 

"The  base  of  the  jack-screw 
in  this  case  is  soldered  to  the  band.  Retention  of  the  tooth 
is  always  anticipated,  and  in  nearly  every  instance  retaining 
tubes  are  soldered  in  position  at  the  beginning  of  an 
operation,  so  that  all  tliat  is  necessary  when  the  tooth  is 
in  place,  is  to  insert  the  gold  retaining  wire  and  remove 
the  power. 

"A  few  of  the  principal  movements  are  selected  for  illus- 
tration from  the  many  modifications  of  which  the  appliances 
are  capable. 

"The  application  and  operation  of  the  direct  screw  is 
shown  in  Fig.  31.  A  firm  anchorage  for  the  resistance  of 
the  screw  is  obtained  by  banding  and  tubing  the  left  cuspid, 
and  passing  through  the  tube  a  piece  of  gold  wire  long- 
enough  to  extend  to  and  rest  against  adjoining  teeth.  The 
opposite  cuspid  is  banded,  and  a  retaining  tube  soldered 
to  the  labial  surface.     The  linsual  surface  has  a  slot  cut 


Lateral  Jloveinent. 


96 


ORTITODONTIA. 


Fl(i.   31. 


in  it  to  receive  tlie  flat  end  of  the  jack-screw.     The  other  en(i 
of  the  tnhe,  in  whicli  the  screw  plays,  is  so  tiled  that  it  rests 

securely  against 
the  re-enforcement 
wire  and  the  tuhe 
upon  the  lingual 
surface  of  tlie  cus- 
]^id  band.  After 
l)eing  brought  into 
position,  the  tooth 
is  held  in  place  by 
passing  a  short 
piece  of  gold  wire 
through  the  re- 
taining    tube    on 


Re-enforoed  Anchorage. 

the  labial  surface,  which  is  left  in  place  until  the  tooth  is 

firmly  set  in  its  new  position. 

"The  backward  movement  of  teeth  in  the  line  of  the 

arch  is  accomplished  by 
the  appliance  shown  in 
Fig.  32.  The  second  bi- 
cuspid and  first  molar  are 
banded,  and  the  tube  of 
the  heavy  traction  screw 
rigidly  soldered  to  the 
bands.  The  cuspid  to  ])e 
moved  is  banded,  and  a 
short  section  of  tubing 
soldered  to  it  to  receive  the 
end  of  i\\c  traction  screw. 
On    turning   the   nut^ 


lietraction  ofCiispif 


traction  is  produced,  iind  the  cuspid  ])ulled  into  place. 
The  cuspid  is  kepi  from  being  rolatcd,  wliilc  it  is  being- 
moved  backward,  by  iiiciins  of  the  short  tube  accurately 
fitting  the  right  angled  end  of  the  traction  screw. 


MATERIALS     AND     METHODS. 


97 


Fi(i.  :^3. 


Increased  Anehoraae. 


Fro.  31. 


"Another  outward  movenu'iit  of  a  tootli  by  means  of  the 
jack-screw,  is, shown  hi  Flo-. 
33.  The  second  bicuspid 
is  made  the  principal  an- 
cliorage,  apiinst  which  the 
base  of  t h e  t  ube  rests.  Tl i  e 
band  encirchni;-  the  hiteral 
incisor  has  a  slot  cut  in  it  to 
receive  the  end  of  the  jack- 
screw.  The  anchorage  is 
re-enforced  by  means  of  a 
wire  loop,  which  hooks 
into  tubes  upon  the  ad- 
joining central  and  cus})id,  and  is  looped  over  a  spur  uj)on 
the  body  of  the  jack-screw  tube.  The  central  and  cuspid 
cannot  l)e  pushed  outward  on  account  of  this  re-enforcement, 
and  three  teeth  constitute  the 
anchorage  instead  of  one.  The 
several  parts  of  this  appliance 
are  shown  in  Fig.  34. 

"  Outward  movement,  as  ac- 
complished  by  anotlier  simple 

means,  is  as  follows:  A  thin  strip  of  band  material  is  looped 
about  the  malposed  tooth,  the  ends  resting  upon  the  labial 
surfaces  of  the  adjoining  teeth.  To  one  end  of  this  strip  is 
soldered  a  tube  placed  vertically,  while  to  the  other  end  a 
similar  tube  is  attached  horizontally.  Into  these  tubes  the 
small  traction  screw  is  placed,  being  bent  to  Fig.  35. 
conform  to  the  shape  of  the  arch,  and  being- 
used  in  this  case  to  push  instead  of  pull. 
The  parts  of  this  device  are  shown  separately 
in  Fig.  35.  The  manner  of  retaining  the  """''ZyemelT"^ 
teeth  in  position,  after  correction,  is  shown 
in  Fig.  3(3. 

"  Rotation  by  this  method,  as  in  most 
others,  is  accomplished  by  the  leverage  and 
elasticitv  of  a  metallic  bar  or  wire  attached        Retention 


Fio.  36. 


98 


ORTlK^nOXTIA. 


Fig.  38. 


to  the  tooth  to  he  rotated,  and  then  sprung  around  to  some 
firmer  tooth  or  teeth  at  a  distance.  Fig.  37  shows  a  lateral 
to  be  rotated,  and  the  appliance  in  position  by  which  it 
Fig.  37.  may  be  accomplished.      The  lateral 

is  banded  and  tubed  as  shown  in  the 
cut.    The  second  bicuspid  is  also  ban- 
ded, and  to  secure  greater  resistance, 
the  two  adjoining  teeth  are  made  to 
assist   by    means  of   a    wire   which 
passes  througli  a  tube  on  the  pala- 
tine surface  and  rests  against  the  first 
bicuspid  and  first  molar.  On  the  buc- 
cal side  of  this  same  band,  the  ends 
of  the  band  material  are 
shaped  into  a  latch  or  hook, 
Avitli  which   the   rotating 
lever  engages  when  it  is 
sprung  around.     The  sev- 
eral parts  of  this  appliance 
are    shown    in    Fig.    38. 
Fig.  39.^    After  the  tooth  is  in  position,  it  is  retained  by 
^^^^^.  means  of  a  short  wire  passing  through  the  tube, 
.™  and  extending  upon  the  central,  as  seen  in  Fig. 
yP  30.     Tliis  wire  is  kept  in  place  by  a  small  pin, 
Retainer.       ^y]^\^.\^  iy  tightly  fitted  in  a  small  hole  drilled 
through  botli  tube  and  wire,  as  shown. 

"When  two  teetli  are  to  be  rotated  in  opposite  directions 
p,(,    4^J  at  the  same  time,  as  the  central  in- 

cisors, double  rotation  may  be  accom- 
plished  l)y  one  appliance,  as  shown 
in  Fig.  40.  Botli  teeth  are  banded, 
and  a  tube  soldered  to  each  band, 
i».,uM«  Rotation.  one  being  horizontal  and  the  other, 

vertical.  A  |)i(('c  of  j)ian()  wire  is  bent  to  a  right  angle  at 
one  end,  and  IIk^u  placed  in  jjosition  as  seen  in  Fig.  41. 
The  tendency  of  the  wire  to  straighten  itself,  will  rotate  both 


MATKKIALS     AND     METHOD!^. 


99 


Double  lioialion. 


Fig.  42. 


teeth  at  once.      When  in  position  they  are  retained  by  sub- 
stituting a    non-ehistic  gohl   wire  pf,;.   41. 
for   the  piano  wire. 

"  Exj)ansion  of  the  arch  is  ac- 
coniphshed  by  banding  and 
tubing  the  first  and  hist  teeth  of 
those  to  be  moved,  on  each  side, 
and  connecting  them  by  means  of  a  wire  passed  through 
the  tubes.  The  jack-screM'  is  then  pLaced  in  position  across 
tlie  arch  from  wire  to  wire.  CoRars,  or  short  tubes,  are  sold- 
ered to  the  wires  at  intervals  to  kee[)  the  screw  in  ])roper 
position.  The  j  a  c  k  - 
screw  may  Ijc  moved 
forward  or  ])ackward 
according  to  the  varying 
requirements  of  the  case. 
This  appliance  in  posi- 
tion is  clearly  shown  in 
Fig.  42." 

Retention  is  always 
anticipated  and  p  r  o  - 
vided  for,  by  means  of 
the  tul)ed  band,  wliile 
the  ijin  device  for  lock- 
ins;  lever  and  tube  to- 


for  Expansion. 


ill 
Aiisile  Devif 

gether,  is  both  novel  and  ingenious.  Aside  Irom  these,  the 
method  contains  so  many  ingenious  modifications  of  pre- 
viously known  devices  (as  the  screw  and  band),  and  is  com- 
posed of  parts  so  simple  and  direct  in  their  action,  that  it 
must  necessarily  commend  itself  to  all  engaged  in  this  line 
of  practice. 

The  various  parts  of  the  Angle  appliances  may  be  obtained 
from  the  inventor,  or  from  the  dental  supply  houses. 

COFFIN'S  METHOD. 

In  a  paper  read  before  the  Dental  Section  of  the  Inter- 
national Medical  Congress,  held  in  London,  in  August,  1881, 


100  oirnioDoxTiA. 

Mv.  Wnltcr  IT.  Coffin  explained  his  metliod  of  correcting 
irregularity  <if  the  teetli.  The  method  was  devised  by  his 
father,  and  had  l)een  in  use  by  fathei'  and  son  for  twenty- 
five  years.  It  was  termed  the  "  Expansion  Method,"  because 
in  nearly  all  eases  coming'  under  their  care,  a  certain  amount 
of  expansion  had  been  found  necessary  in  connection  with 
other  desired  movements. 

The  construction  of  the  appliance,  and  the  principle  upon 
which  it  acts,  are  exceedingly  simple.  The  power  is  derived 
from  the  elasticity  of  piano-forte  wire,  attached  in  various 
ways  to  a  vulcanite  plate  which  covers  the  arch  (in  an  upper 
case)  and  envelopes  the  posterior  teeth  on  either  side  to  give 
it  firmness  and  fixedness  in  position.  AVhen  it  is  desired 
to  expand  the  superior  arch,  the  wire  is  l)ent  into  the  fol- 
lowing form  iSlS ,  lyiiig  on  top  of  the  plate  ^\'ith  the  ends 
embedded  in  it. 

To  produce  lateral  expansion  in  the  lower  jaw,  the  form 
of  the  appliance  is  necessarily  different.  A  simple  vulcanite 
plate  is  made  in  horse-shoe  form,  fitting  the  gum  and  lingual 
surfaces  of  the  teeth,  and  capping  the  molars  and  bicus- 
pids. On  the  lingual  surface  of  this  plate,  lie  two  pieces  of 
piano  wire  suitably  curved,  with  their  ends  imbedded  in  the 
rublier. 

Each  of  these  plates  wlien  completed,  is  sawn  in  two  along 
the  median  line,  thus  allowing  the  tension  of  the  wire  to  be 
increased  from  time  to  time,  by  spreading  apart  the  sections 
of  the  plate. 

The  piano-forte  wire  used  may  be  obtained  from  piano 
factories  or  from  dealers  in  dental  supplies.  It  is  sim])ly 
wire  made  from  the  best  quality  of  steel,  drawn  to  size 
through  draw-plates.  The  (juality  of  tlu>  steel,  as  well  as 
the  toughness  of  the  wire,  is  greatly  iin])roved  l)y  the  suc- 
cessive drawings  to  which  it  has  been  subjected.  For  ordi- 
nary cases  Mr.  Cotlin  reeoiiiniends  lliat  the  dinincter  (»f  tlie 
wii-e  be  between  three  and  foui' one-hundredths  of  an  inch. 
A  lighter  or  heavier  number  will  \'ield  respectively  less  or 
greater  pressure. 


MATKUIALS     AND     ^fETHODS.  101 

In  iisL'  it  .should  not  be  aniu'aled,  but  V)cnt  to  shape  as  it 
comes.  Mr.  Cofiiii  recommeiuls  tliat  the  wire  be  tinned  after 
l)ein.ii-  l)ent  to  sha])e,  to  prevent  oxidation  in  the  moutli,  but 
this  does  not  appear  to  be  necessary. 

A  wire  suitaldy  l)ent  to  pro(hice 
ex})ansion  of  the  su])erior  arch  is 
represented  by  Fi^-.  43. 
■  Tlie  details  of  tlie  construction  of 
an  expansion  plate  for  the  superior 
jaw.  are  as  follows :  From  an  accurate  ^  cottin  spring. 
impression  of  the  jaw  and  teeth,  taken  with  plasterer  model- 
ling compound,  a  pla.ster  model  is  ol)tained.  I'pon  this  a 
wax  base-})late  is  fashioned,  to  cover  all  parts  intended  to  l)e 
covered  l)y  the  com})leted  plate.  The  suitaldy  lient  wire  is 
now  further  shaped  so  that  it  shall  lie  upon  the  exposed 
surface  of  the  base-plate,  and  conform  to  it  as  closely  as 
possible  in  outline.  After  the  ends  of  the  wire  are  attached 
to  the  base-plate  by  means  of  additional  wax,  a  piece  of  tin- 
foil (No.  ()0)  is  slipped  between  the  wire  and  the  plate  and 
its  corners  bent,  so  that  the  plaster  when  jjoured  into  the 
flask  will  grasp  and  remove  it  with  tlie  wire.  The  foil  is 
placed  there  so  tliat  the  plate  will  have  a  polished  surface 
under  tlie  wire  after  vulcanization.  The  wax  base-plate 
should  now  be  smoothed  with  a  s|)atula  and  flasked  in  the 
usual  manner.  In  .separating  the  flask,  the  wire  and  tin-foil 
will  come  away  with  the  upper  half,  while  the  model  will 
remain  in  the  lower.  After  removing  the  wax  and  packing 
the  ru]d)er,  the  case  is  vulcanized,  after  which  it  is  polished. 
The  completed  piece  should  now  be  properly  fitted  to  the 
patient's  mouth,  and  the  rubber  covering  the  masticating 
surfaces  of  the  po.sterior  teeth  so  filed  and  dressed  that  the 
cusps  of  the  occluding  teeth  will  all  .strike  the  rubber  at  the 
same  time. 

However  many  or  few  of  the  natural  teeth  be  covered,  the 
last  ones  in  the  arch  must  always  be  included,  as  otherwise 
they  would  elongate  through  non-occlusion,  and  thus  seri- 
ously impair  the  usefulness  of  the  masticatory  apparatus. 


102 


ORTIIQDONTIA. 


Fig.   44. 


After  tlie  plate  has  been  fitted,  it  ^liould  Ije  .•<awn  in  two  with 
a  jeweler's  fine  saw,  the  edges  made  smooth  and  slightly 
rounded,  and  the  case  introduced  into  the  mouth. 

It  is  desirable  to  have  the  patient  Avear  the  plate  for  a  day 
without  eidargemeiit.  after  Avhich,  at  intervals  of  a  day 
or  two,  the  tension  of  the  wires  should  be  increased  by 
pulling  the  halves  of  the  plate  apart  sufficiently  to  slightly 
increase  the  space  between  them.  Only  the  fingers  should 
be  used  in  thus  spreading  the  plate,  for  if  pliers  be  used 
upon  the  wire  for  this  purpose,  the  relation  between  the  two 
halves  may  be  so  disturbed  as  to  destroy  the  usefulness  of  the 
plate.  The  construction  of  the  lower  plate  is  substantially 
the  same,  only  the  wires  lie  against  the  plate  in  a  continuous 
smooth  curve,  instead  of  being  corrugated. 

Figs.  44  and  45  represent  an  upjjer  and  lower  cxj)ansion 

plate  as  described. 
For  cases  where 
expansion  is  not 
needed,  but  simply 
the  moving  of  one 
or  more  teeth,  Mr. 
Coffin  uses  a  solid 
rubber  plate,  with 
wires  so  placed  as 
to  produce  the  de- 
sired movements. 
The  construction 
of  this  form  of 
plate  is  the  same 
as  those  just  de- 
scribed, with  the 
exception  of  the 
shajje  and  arrange- 
ment of  the  wires 
and  the  non-sepa- 

Coffin'B  Expansion  Plates.  ratioU  of  the  plate. 

A  single  long  piece  of  wire,  bent  at  right  angles  near  one 


FUi.   45. 


MATERIALS     AND     METHODS.  103 

end  and  flattened  at  tlio  other,  is  embedded  at  its  flattened 
end  into  tlie  plate;  wliile  the  other  end,  and  a  long  i)ortion 
besides  is  free  and  lies  in  close  apposition  to  the  plate.  Be- 
fore the  wire  is  attached  to  the  wax  base-plate,  the  plaster 
tooth  representing  tlie  one  to  be  moA^ed  should  l)e  ent  away 
close  to  its  neck  and  the  l)ent  end  of  the  wire  laid  ni)on  it 
so  as  to  cover  the  entire  diameter  of  the  stub  tooth.  In  this 
position  it  is  vulcanized  to  the  plate. 

When  the  plate  is  introduced,  the  wire  will  have  to  be 
drawn  back  with  an  instrument  or  string,  before  the  plate 
Avill  go  into  j)osition.  Once  in  place,  and  the  wire  released, 
continuous  pressure  will  be  exerted  on  the  malposed  tooth. 
After  the  tension  of  the  wire  has  been  lessened  l)y  the  moving 
of  the  tooth,  it  may  be  increased  either  by  Ijending  tlie  wire 
where  it  enters  the  plate  or  by  cutting  it  out  and  re-setting 
in  a  different  position. 

Another  and  very  convenient  way  of  lengthening  the 
wires  to  follow  the  moving  tooth,  is  to  slip  a  section  of  plati- 
num or  German  silver  tubing  over  the  end  of  the  wire  and 
soft-solder  it  in  position. 

AVhere  a  tooth  is  to  be  pressed  outward,  the  wire  is  anchored 
in  the  palatal  portion  of  the  plate;  but  where  a  tooth  is  to 
be  moved  from  witliout  inward,  the  wire  should  be  attached 
to  that  portion  of  the  plate  covering  the  buccal  surfaces  of 
the  molars. 

Rotation  is  accomplished  l)y  combining  the  two  move- 
ments ;  that  is,  by  having  one  wire  on  the  palatine  surface 
to  press  against  one  angle  of  the  tooth,  and  another  on  the 
buccal  surface  to  press  against  the  opposite  angle. 

Two  wires  can  be  inserted  to  operate  on  two  teeth  at  the 
same  time,  either  in  similar  or  opposite  directions.  Fig.  46 
represents  a  plate  made  to  press  outward  two  lateral  incisors. 

Many  modiflcations  of  the  Coffin  plate  have  been  devised 
by  different  practitioners,  some  of  which  are  shown  in 
Part  TIL 


104 


ORTITODONTIA. 


Fig.  46. 


Tlie  originator  claims  for  his  iiiethod  and  appliances,  sim- 
plicity, ease  of  construction  and  inexpensiveness,  almost 
universal  range  of  application,  perfect  control  of  force  applied 

and  direct  action,  com- 
parative painlessness  from 
non-irritation  of  the  soft 
tissues,  perfect  fixedness 
and  least  unsightliness, 
ease  of  removal  for  cleans- 
ing, and  little  interference 
with  speech  and  mastica- 
tion. All  these  claims 
must,  we  think,  be  granted; 
Coffin  Solid  Plate.  and  lu  doiug  so,  we  prob- 

ably accord  it  the  highest  place  among  the  methods  devised 
for  the  correction  of  dental  irregularities. 

TALBOT'S  METHOD. 

Dr.  E.  S.  Talbot*  has  designed  a  modification  of  the  Coffin 
piano-wire  spring,  which  consists  in  converting  it  into  a  coil 
at  some  point  of  its  length,  thus  adding,  it  is  claimed,  greater 
•elasticity  and  a  wider  range  of  applicability.  Unlike  the 
Coffin  spring  it  may  be  used  without  a  rubber  plate  and 
without  being  permanently  attached  to  any  appliance.  The 
€oil  is  formed  by  bending  the  wire  around  a  mandril  firmly 
driven  into  the  bench  or  properly  secured  in  a  vise. 

The  arms  may  be  bent  or  cut  to  any  length  to  suit  the 
case  in  hand.  They  may  be  used  in  connection  with  a 
ruljl)er  })latc,  oy  Avith  bands  of  gold  or  platinum  fastened  to 
the  teeth  with  zinc-})liospliate.  With  holes  properly  drilled 
in  the  bands  or  j^late  and  the  arms  fitted  into  them,  the 
spring  will  stay  in  position.  When  the  s[)riiig  is  used  with- 
out a  plate  it  may  be  well  to  fasten  the  wire  to  some  of  the 


*Ta]l)ot'.s  "Irregularities  of  the  Teetli,"  page  126. 


MATERIALS     AND     METHODS. 


105 


teeth    to  ])ixvt'iit  its  being  swallowed.      Fig.  47  illustrates 

the       coil  Fic^.  47. 

spring      in 

sonic    of    its 

forms.      To 

prevent    t  li  e 

spring    from 

rocking    i  n 

the    mouth 

the     coil      is  Talbot  Colled  springs. 

usually  made  to  press  over  a  button  or  Y)o^{  suitalily  placed 
on  the  plate  for  that  purpose. 

Fig.  48  shows  a  case  Fi«-  ^^■ 

treated  by  Dr.  .J.  F. 
Austin,  in  which  tlie 
Talbot  spring  in  a  small 
form  was  made  use  of 
to  press  apart  adjoining- 
teeth  to  make  room  for 
rotating  and  bringing 
into  place  a  lateral 
incisor  that  was  mal- 
posed. 

Fig.  49  represents  the  application 
and  use  of  the  coil  spring  in  widen- 
ing the  lower  arch.  The  plate  is 
slotted  after  the  Kingsley  plan,  in 
such  a  way  that  the  partly  separated 
portions  may  move  independently 
of  the  rest  of  the  plate.  Near  the 
free    extremities   of    each    of  these 

tongues  a  hole  is  drilled  to  receive    slotted  vuieanite  piate  ana 
the  ends  of  the  coil  spring,  the  coiled 

portion  resting  against  the  anterior  2:)ortion  of  the  plate.  In 
this  way  the  bicuspid  teeth  will  be  moved  more  rapidly 
than  the  molars. 


Coiled  Spring  in  Position. 
Fig.  49. 


106 


ORTHODONTIA. 


An  illustration  of  the 
use  of  the  coil  spring  with- 
out a  rubber  plate  is  given 
in  Fig.  50.  In  this  case 
p  1  a  t  i  n  u  m  b  a  n  d  s  w  e  r  e 
cemented  to  the  laterals 
., -v/.  /  4%»aas»i^and  the  ends  of  the  coil 
spring  rested  in  small  holes 
drilled  in  the  bands  for 
the  purpose.  The  action  of  the  .spring  forced  the  laterals 
out  of  lock,  after  which  they  were  brought  into  proper 
position  by  means  of  other  appliances. 

The  coiled  .spring,  in  many  cases,  possesses  advantages 
over  the  plain  spring  because  it  can  be  effectively  used 
where  the  other  cannot.  It  is  also  more  easily  regulated  as 
to  tension,  and  can  be  readily  replaced  by  a  weaker  or 
stronger  one  should  the  case  require  it. 


Coiled  Spring  aud  Platinum  Bands. 


PART  III. 

SPECIFIC  FORMS  OF  IRREGULARITY  AND  THEIR 
TREATMENT. 

While  principles  and  methods  may  be  well  understood, 
illustrations  of  their  application  in  certain  forms  of  irregu- 
larity will  be  necessary  in  order  that  the  student  may 
properly  comprehend  their  practical  relationship. 

So  far  as  ease  or  difhculty  of  treatment  is  concerned,  cases 
of  irregularity  are  naturally  divided  into  two  general  classes  ; 
in  one  the  cases  are  brought  to  our  notice  as  soon  as  the 
irregularity  begins  to  manifest  itself,  while  in  the  other  the 
deformity  is  fully  established  and  confirmed  before  presenta- 
tion for  treatment.  In  the  first  class,  occurring  usually  in 
children,  we  have  the  advantages  of  easy  movement  and 
freedom  from  complications ;  while  in  the  second,  we  have 
to  contend  with  slow  and  difficult  movement  and  a  variety 
of  unfavoring  conditions. 

For  these  reasons  it  is  deemed  advisable  to  treat  of  certain 
forms  of  irregularity,  especiall}'  those  involving  the  six 
anterior  teeth  of  each  jaw,  under  separate  heads,  according 
as  they  present  before  or  after  dentition  is  complete,  for  the 
treatment  in  one  case  will  vary  considerably  from  that 
required  in  the  other. 

(107) 


CHAPTER  I. 

INCISOR  TEETH  ERUPTING  OUTSIDE  OK  INSIDE  OF  THE  ARCH. 

Reference  has  already  been  made  to  the  fact  that  normally 
the  permanent  inferior  incisors  erupt  inside  of  the  arch 
and  posteriorly  to  the  deciduous  ones,  wliile  the  permanent 
superior  incisors  erupt  outside  of  their  deciduous  prede- 
cessors. From  the  limited  space  allotted  to  them,  there 
is  a  stronger  tendency  to  irregularity  on  the  part  of  the 
lower  incisors  than  tliere  is  on  the  part  of  the  more  favor- 
ably located  superior  ones,  although  tlie  latter  are  also  often 
found  in  a  crowded  condition,  sometimes  complicated  with 
torsion. 

So  long  as  the  inferior  ones  are  within  the  arch,  even 
though  irregularly  arranged,  they  will  usually  need  no  atten- 
tion on  our  part  until  dentition  is  com[»lete ;  and  wliou  tliat 
time  arrives  it  will  generally  be  found  tliat  nature  lias  al- 
most, if  not  entirely,  corrected  the  condition. 

So,  also,  where  some  of  tlie  su}»('rior  incisors  erupt  slightly 
outside  of  the  arcli,  tliey  Ijcing  still  in  line,  with  spaces 
between  tliem,  we  need  nut  interfere,  fur  in  most  cases  the 
force  exerted  by  the  lips  and  the  erupting  cuspids  will  bring 
them  into  normal  pf)sition  and  relationship. 

It  not  unfrequently  happens,  however,  that  from  some 
cau.se  a  superior  incisor  is  deflected  in  its  eruption  and 
appears  inside  of  the  arch,  or  that  an  inferior  incisor  is  found 
to  eru[)t  outside  of  the  arch.  In  either  case,  treatment  is 
indicated  as  soon  as  the  irregular  tooth  or  teeth  are  sufR- 
ciently  erupted  to  enable  us  to  bring  the  ]»i'oj»c'r  force  to  bear 
upon  them. 

(108) 


PRACTICAL    TREATMENT.  109 

Where  one  or  two  of  the  su])eri(jr  incisors  erupt  inside  of 
the  arch,  a  very  ready  manner  of  bring- 
ing them  out  into  line   is  by  tlie  use  of 
the  "saddle  and  inclined  plane," as sh()\vii 
in  Fig.  51. 

It  is  commonly  made  of  silver  })late,  in.iined  piane, 
gauge  26,  swaged  in  a  single  piece  to  cover  all  of  the  crowns 
of  the  inferior  incisors  and  cuspids.  At  a  point  where  the 
introverted  upper  tooth  touches  this  plate,  a  piece  of  heavy 
silver,  gauge  22,  is  soldered  in  an  inclined  position  to  the 
ridge  of  the  saddle.  With  this  appliance  in  position,  the 
malposed  tooth  is  readily  brought  forward  into  line, 
through  the  force  exerted  upon  it  in  mastication.  Where 
more  than  one  tooth  is  to  be  moved,  corresponding  inclined 
planes  are  attached  to  the  saddle  for  each  one. 

To  insure  a  close  fit  and  stability  for  the  piece,  it  is  well 
to  scrape  slightly  the  neck  of  each  plaster  tooth  on  the 
model,  both  on  the  lingual  and  labial  aspect,  before  casting 
the  die.  With  the  appliance  properly  constructed,  so  as  to 
bind  upon  each  tooth  at  its  neck,  it  will  usually  retain  its 
position  during  the  ten  or  fifteen  days  necessary  for  bringing 
one  or  two  teeth  into  place. 

To  avoid  the  necessity  of  removal  for  cleansing  and  the 
possible  non-replacement  of  the  a]i)pliancc  l^y  the  patient,  as 
well  as  to  secure  it  in  position  more  effectually,  the  writer  has 
been  in  the  habit  of  cementing  it  to  the  teeth  with  phos- 
phate of  zinc  cement,  in  the  same  manner  as  crown  and 
bridge-work  is  attached. 

Two  principal  objections  have  been  urged  against  this 
appliance :  one,  that  by  thus  opening  the  bite,  the  posterior 
teeth  will  elongate ;  the  other,  that  the  patient  may  avoid 
biting  upon  the  plane.  These  objections  have  no  real  valid- 
ity, as  is  shown  by  actual  experience. 

The  short  time  that  the  bite  is  kept  open  is  not  long 
enough  to  permit  of  any  perceptible  elongation,  and  the 
patient  must  and  does  bite  upon  the  plane  in  mastication, 
because  it  is  the  only  point  where  occlusion  is  possible. 


110  ORTHODONTIA. 

In  cases  where  a  lower  incisor  is  locked  out  of  the  arch  by 
a  superior  one  biting  inside  of  it,  both  teeth  can  be  moved 
in  opposite  directions  and  brought  into  line  bj'  means  of  an 
appliance  devised  by  the  author  many  years  ago.  It  is  con- 
structed as  follows :  A  band  of  thin  platinum  plate  (No.  29, 
Am.  gauge)  is  bent  to  encircle  and  fit  the  protruding  lower 
incisor,  and  the  ends  soldered.  A  piece  of  ordinary  gold 
plate  is  then  bent  double  to  form  the  plane,  and  spread  apart 
at  its  ends  to  grasp  tlie  band  on  the  lingual  and  labial  sur- 
faces, to  which  it  is  soldered.  It  is  next  placed  upon  the 
tooth  to  see  that  the  adjustment  is  correct,  removed,  lined 
with  phosphate  of  zinc,  and  pressed  permanently  into  posi- 
tion. If  the. teeth  are  in  close  contact  it  is  well  to  allow  the 
fixture  to  be  worn  a  day  previous  to  cementing,  for  then  the 
teeth  will  have  been  pressed  apart  and  the  replacement  with 
cement  will  be  more  easily  accomplished.  The  cement  not 
only  lines  the  band.  l)ut  fills  up  all  the  space  between  the 
plane  and  the  tooth,  thus  giving  greater  resist- 
ance and  strength  in  biting.  It  is  sho^'n  in 
position  and  separately,  in  Fig.  52.  Its  ad- 
vantages are  its  small  size  and  absolute 
fixedness.  When  the  correction  has  been 
accomplished,  it  will  be  necessary  to  cut  the 
band  in  order  to  remove  it. 
Fixed  Plane.  Auothcr  plan  of  accomjDlishing  the  same  end 
is  that  devised  by  Prof.  C.  N.  Peirce.  He  simply  attaches 
ligatures  to  several  or  all  of  the  lower  incisors,  and  makes 
these  fast  to  the  molars  on  either  side.  The  ligatures  being 
attached  and  drawn  tight  while  dry,  will,  under  moisture, 
contract  and  draw  the  incisors  inward.  This  operation  is 
continued  until  the  lower  incisors  reach  a  po.sition  inside  or 
back  of  the  malposed  superior  ones.  The  ligatures  are  then 
removed,  and  the  lower  teeth,  in  gradually  resuming  the 
position  they  formerly  occupied,  will  carry  the  inlocked 
superior  ones  with  them. 
Where,  for  any  cause,  it  is  desirable  to  confine  the  means 


PRACTICAL    TREATMENT. 


Ill 


of  correction  to  the  jaw  in  which  the  irregnlai'ity  exists,  as 
for  instance  where  the  superior  hiterals  are  inlocked,  a  sim- 
ple plan  is  to  take  a  piece  of  platinized  gold,  about  one- 
eighth  of  an  inch  in  width  and  long  enough  to  more  tlian 
cover  the  four  incisors,  and  punch  or  drill  four  lioles  in  it, 
two  opposite  each  of  tlie  laterals.  The  bar  being  laid  in 
position  on  the  labial  surfaces  of  the  centrals,  the  laterals 
are  securely  ligated  to  it,  the  thread  passing  through  the 
holes.  The  spring  of  the  bar  and  the  contraction  of  the 
moist  ligatures,  will  move  the  laterals  into  position  in  a 
short  time,  the  ligatures  being  renewed  ever}^  two  or  three 
days. 

A  more  satisfactory  way  of  performing  this  operation,  is 
to  solder  one  end  of  the  bar  to  a  platinum  band  made  to 
encircle  one  of  the  laterals  and  attached  to  it  by  zinc  cement. 
Arranged  in  this  way,  the  bar  has  but  one  free  end,  which 
is  the  more  readily  ligated  to  the  other  lateral. 

Fig.  53  illustrates  an  appliance  of  this  character,  that  was 
used  to  bring  out  into  posi-  pj^,    53 

tion  two  superior  laterals  in 
the  mouth  of  a  girl  ten  years 
of  age.  The  case  was  compli- 
cated by  one  of  the  centrals 
being  slightly  turned  upon 
its  axis. 

A  platinum  band  or  collar 
was  made  to  fit  the  right  lat- 
eral, and  to  its  laV)ial  surface  spring  Bar. 
was  soldered  one  end  of  a  ])ar  of  spring  gold,  long  enough  to 
extend  over  the  centrals  and  cover  the  opposite  lateral. 
The  bar  was  converted  into  a  hook  at  its  free  end,  and  w\as 
so  shaped  that  in  its  course  it  touched  only  the  prominent 
edge  of  the  twisted  central.  The  band  was  then  cemented 
to  the  right  lateral,  and  a  section  of  small  rubber  tubing 
passed  under  the  left  lateral  and  caught  in  the  hook.  The 
appliance  thus  operated  in  two  ways :    First,  to  bring  the 


112 


ORTHODONTIA. 


Fig.  54. 


laterals  out   into  line ;    and  next,  to  press  backward  and 
inward  the  protruding  corner  of  the  central. 

Another  way  of  securing  the  same  result  is  by  the  use  of  a 

Coffin  plate  and  suita- 
bl}''  shaped  extension 
wires,  as  shown  in  Fig. 
54. 

The  rubber  plate  is 
made  to  cover  the  arch 
and  enclose  several  bi- 
cuspids or  molars  on 
each  side.  In  each  of 
the  buccal  portions  of 
the  plate  a  piece  of  piano 
wire  is  imbedded,  which 
extends  forward  clear  of  the  teeth  and  terminates  in  a  curve 
or  hook  opposite  the  tooth  to  be  moved  outward.  A  section 
of  rubber  tubing  is  slipped  over  the  tooth  and  caught  upon 
the  hook.  The  elasticity  of  the  rubber,  added  to  the  spring 
of  the  metal,  will  rapidly  draw  the  tooth  outward  provided 
there  is  sufficient  space  in  the  arch  to  accommodate  it. 

As  already  stated,  slight  spaces  existing  between  the 
superior  incisors  when  recently  erupted  need  give  us  no 
concern,  provided  they  are  in  the  nor- 
mal line  of  the  arch  ;  but  it  often  hap- 
pens that  in  addition  to  the  spacing, 
one  or  more  of  them  is,  to  a  greater  or 
less  extent,  turned  upon  its  axis,  as 
shown  in  Fig.  oo. 

In  other  cases  the  teeth  may  be  in 
contact,  while  one  of  them  is  twisted 
and  overlapping  its  neighbor,  as  shown 
in  Fig.  56.  In  either  case  it  is  quite 
probable  that  the  cutting  edge  of  the 
Torsion  with  Overlapping.  ^^^,j^^,j  ^^^^j^  ^^,-^^  occludc  with  the  Cor- 
responding surface  of  the  one  in  the  opposite   jaw  at  an 


Fig.  55. 


Torsion  with  Space. 


Fig.  .)«. 


PRACTICAL    TREAT^FEXT.  113 

angle,  and  thus  either  prevent  full  eruption  of  one  or  the 
other  of  the  teeth,  or  temporarily  open  the  bite  and  favor 
undue  elongation  of  posterior  teeth. 

Both  of  these  forms  of  irregularity  should  receive  im- 
mediate attention,  for  at  an  early  age  correction  is  easily 
accomplished.  AVere  the  conditon  to  remain  unchanged, 
it  would  necessarily  become  more  complicated  from  partial 
closure  of  the  space  caused  by  the  lateral  pressure  that 
would  be  exerted  during  the  eruption  of  neighboring  teeth. 

Rotation  of  these  teeth,  as  well  as  of  others,  may  be 
accom})lished  l)y  one  of  the  many  methods  described  in 
C'ha])ter  XL 


CHAPTER  II. 

DELAYED  OR  MAI^ERUPTIOX  OF  THE  PERMAXEXT  CUSPIDS. 

The  third  molars  excepted,  the  cuspids  are  usually  the  last 
teeth  of  the  permanent  set  to  erupt,  and  they  almost  invaria- 
bly make  their  appearance  outside  of  the  arch.  When  there 
is  room  in  the  arch  for  their  accommodation  and  they  erupt 
directly  outside  of  it,  we  may  feel  assured  that  in  due  time 
they  will  find  their  way  into  place  unaided.  Where,  however, 
they  erupt  over  the  lateral  incisors,  as  is  sometimes  the  case, 
and  these  incisors  are  in  consequence  being  forced  inward 
from  their  true  position,  it  becomes  necessary  for  us  to  inter- 
fere and  endeavor  to  draw  the  cuspids  toward  their  proper 
places.  This  is  usually  not  a  difficult  matter  when  the  cus- 
pid crown  is  far  enough  erupted  to  enable  us  to  apply  pres- 
sure upon  it.  In  such  a  case,  by  cementing  a  Magill  band 
to  the  cuspid  and  another  to  the  second  bicuspid  or  first 
molar,  each  having  a  pin  or  hook  attached  to  its  buccal  sur- 
face, a  rubber  ring  extending  from  hook  to  hook  will,  in  a 
short  time,  draw  the  cuspid  back  to  a  position  opposite  the 
space  it  is  to  occupy  as  illustrated  in  Fig.  78. 

It  sometimes  happens,  however,  that  the  cuspids  are  tard}" 
in  their  eruption  and  fail  to  assume  their  positions  in  the 
arch  at  the  time  they  are  needed  to  complete  the  row  and 
prevent  the  incisors  and  bicuspids  from  encroaching  upon 
the  space  the  cuspids  are  to  occupy.  In  such  cases  it  is  gen- 
erally advisable  to  hasten  their  eruption  by  the  application 
of  tractile  force  in  some  manner.  AVhere  one-half  of  tlie 
crown  is  through  the  gum  we  can  attach  to  it  a  Magill  band 
witli  a  pin,  hook  or  other  projection  upon  it,  and  Ijy  its 
as.sistance  readily  apply  power  to  the  tooth. 

The  author  lias  had  several  cases  where  elongation  of  the 

(114) 


PRACTICAL  trp:atment.  115 

cuspid  was  called  for,  when  only  the  cusp  of  the  tooth  was 
visible  through  the  gum.  Here,  the  application  of  a  cemented 
band  was  out  of  the  question,  and  attachment  to  the  tooth 
had  to  be  gained  in  another  way.  The  difficulty  was  solved 
by  tying  a  silk  ligature  in  a  half  knot,  passing  it  over  the 
projecting  cusp,  and  then  with  a  small,  flat  plugger,  forc- 
ing this  ligature  up  under  both  gum  and  alveolus  until 
it  encircled  the  neck  of  the  tooth,  when  it  was  drawn  tight 
and  made  fast  with  a  surgeon's  knot.  A  very  small  gold 
ring,  with  a  centre  only  large  enough  to  admit  of  the  passage 
of  silk  floss,  was  then  slipped  over  one  of  the  ends  of  the 
ligature  and  tied  so  that  it  would  lie  upon  the  labial  face  of 
the  tooth  near  the  gum.  This  ring  was  allowed  to  remain 
without  change  until  the  tooth  was  drawn  into  position.  A 
delicate  vulcanite  plate  was  constructed  to  fit  the  arch,  and 
extend  into  the  space  between  the  lateral  and  first  bicuspid. 
At  this  latter  point  the  plate  was  thickened  until  it  was 
nearly  on  a  level  with  the  cutting  edges  of  the  adjoining 
teeth,  and  made  concave  on  its  most  prominent  part.  A 
rubber  spur  was  also  formed  on  the  plate,  in  a  line  with  the 
cuspid  and  space.  The  plate  being  in  position,  a  rubber 
band  was  passed  over  the  spur  and  drawn  tight  to  the  ring 
on  the  tooth  by  means  of  a  ligature,  the  band  in  its  course 
resting  in  the  notch  of  the  elevation  on  the  plate.  By  this 
arrangement  no  pain  was  infiicted  except  that  incident  to 
forcing  the  ligature  into  position  under  the  gum,  while  power 
was  exerted  in  a  nearly  direct  line  with  the  long  axis  of  the 
tooth,  and  in  a  gentle,  continuous  manner. 

Another  and  most  excellent  plan  of  securing  attachment 
to  a  partially  erupted  cuspid,  is  that  devised  by  Prof.  J.  F. 
Flagg.  It  consists  in  screwing  a  gold  ring-bolt  or  screw-eye 
into  the  point  of  the  cusp.  The  screw-eye  can  be  made  by 
soldering  a  small  gold  ring  to  the  end  of  a  section  of  threaded 
gold  wire.  After  the  correction  is  accomplished,  the  screw 
is  removed  and  the  hole  filled  with  gold. 

If  mal-position  of  an  erupting  cuspid  should  be  compli- 


116  ORTHODONTIA. 

cated  with  more  or  less  torsion,  the  correction  of  the  hitter 
will  be  best  accomplished  after  the  tooth  is  nearly  or  quite 
in  position. 

When  a  superior  cuspid  eru})ts  inside  of  the  arch,  it  may 
either  be  forced  outward  by  a  Coffin  plate  and  spring,  or  it 
may  be  drawn  outward  by  one  of  the  several  methods  men- 
tioned for  similar  operation  upon  the  incisor  teeth. 

The  difficulty  of  gaining  a  firm  hold  upon  a  cuspid  tooth, 
owing  to  its  round  and  conical  form,  may  be  overcome  by 
encircling  it  with  a  Magill  band.  To  this  any  desired  at- 
tachment can  be  made. 


CHAPTER   III. 

INCISOK  TEETH    SITUATED   OUTSIDE  OR  INSIDE  OF  THE  ARCH 
AFTER  DENTITION  IS  COMPLETE. 

Irregularities  of  this  character  will  require  much  the  same 
treatment  as  is  given  to  similar  cases  occurring  during  den- 
tition, but  the  attendant  difficulties  will  be  greater,  owing  to 
the  greater  density  of  the  alveolar  structure  and  the  pres- 
ence of  all  the  teeth,  making  the  obtaining  of  space  more 
difficult.  In  the  lower  jaw,  the  irregularity  in  most  cases  is 
confined  to  one  or  two  teeth,  standing  either  anteriorly  or 
posteriorly  to  the  line  of  the  arch.  If  they  are  located  pos- 
teriorly, and  the  extraction  of  one  of  them  be  not  indicated, 
room  should  be  made  (if  it  p^^,    ^^ 

does  not  exist)  by  pressing 
apart  the  neighboring  teeth. 
After  this  is  done  they  may 
be  conveniently  forced  into 
place  by  means  of  a  C'offin 
plate,  constructed  as  shown 
in  Fig.  57. 

Or,  if  it  be  desired  to  in- 
terfere   less  with    the    tongue  Comn  Plute  tor  Lower  Incisors. 

in  speech,  the  wires,  made  to  describe  a  slight  curve  and 
W' ithout  angles,  may  be  anchored  in  the  plate  on  the  outside. 
Their  free  ends  may  then  be  drawn  down  and  made  fast  to 
the  in-lying  teeth,  eitlier  l)y  means  of  a  silk  ligature  or  rub- 
ber ring,  as  shown  in  Fig.  54. 

Where  it  is  desired  to  move  outward  a  single  incisor,  and 
at  the  same  time  create  space  for  its  accommodation,  an 
excellent  method  for  its  accomplishment  is  that  devised  by 
Dr.  A.  E.  Matteson.* 

*  Dental  Cosmos,  Vol.  XXX,  p.  6S. 

(117) 


lis 


OETHODONTIA. 


Fig. 


Mattesoii    Coiled 
Spring. 


The  apparatus  con.sists  of  two  separate  parts,  a  narroAV 

ribbon  of  thin  gold  or  platinum,  and  a  coiled  spring  of  piano 

wire.     The  ribl)on  is  cut  of  sufficient  length  to  pass  around 

tlie  in-lying  tooth,  and  over  tlie  labial  sur- 

iP (s^        faces  of  the  two  adjoining  ones.     The  spring 

(g/  %)     is  made  from  piano  wire,  Xo.  14  or  16,  and 

bent  to  the  shape  shown  in  Fig.  58. 

After  the  spring  is  constructed,  the  ribbon 
is  placed  in  position  and  the  spring,  with  its 
ends  drawn  closer  together  by  means  of  a 
ligature,  is  laid  upon  it,  and  the  points  where 
the  ends  of  the  spring  touch  the  ribbon 
marked  with  a  pencil  or  sharp  instrument.  The  ribbon  is 
then  removed  and  a  hole  punched  near  each  end  oj^posite 
the  marks,  after  which  it  is  again  properly  placed  upon  the 
teeth,  the  ends  of  the  spring  placed  in  the  holes,  and  the 
restraining  ligature  severed.     Pressure  begins  at  once  and 

continues  uninterrupt- 
edly until  the  tension 
is  spent  and  the  teeth 
moved.  The  ai3i")liance 
in  position  is  shown  in 
^ig.  59. 

Should  the  tension  of 
the  spring  not  be  suffi- 
cient to  move  the  tooth 
entirely  into  place,  the  appliance  should  be  removed,  new 
holes  punched  in  the  ribbon  nearer  its  centre,  and  reapplied. 
The  case  of  irregularity  shown,  was  corrected  by  the  use  of 
this  appliance  in  ten  daj's. 

Where  a  ribV:)on  is  inadmissable  on  account  of  a  close  bite, 
Dr.  Matteson  sulj.stitutes  a  piece  of  gilling  twine,  one  end  of 
which  he  fastens  to  one  eye  of  the  spring  by  means  of  a 
slip-knot,  and  the  other,  after  passing  around  the  tooth  to  be 
moved,  is  secured  to  the  other  eye.  The  ligature  is  now  cut, 
and  the  spring  operates  as  in  the  previous  instance.     Dr. 


Fig.  59. 


Matteson  Appliance  in  Position. 


PRACTICAL    TREATMENT.  119 

Matteson  says :  "  By  the  use  of  a  longer  compound  spring, 
several  teeth  may  be  brought  into  line  at  the  same  time. 
For  example,  where  the  lower  incisors  are  in  a  'jumbled' 
condition,  the  ribbon  or  ligature  may  be  woven  in  and  out 
among  the  proper  teeth  in  such  a  way  that  when  the  power 
of  the  spring  is  exerted  some  teeth  will  be  pushed  apart  to 
make  room  for  others  which  are  being  pulled  into  place." 

Another  manner  of  using  the  metal  ribbon  for  drawing- 
outward  an  inlocked  incisor,  and  at  the  same  time  creating 
space  for  its  accommodation  by  pressing  apart  the  adjoining 
teeth,  is  that  suggested  by  Prof.  Angle  and  noticed  in  the 
description  of  his  method.  The  ribbon  being  of  suthcient 
length  to  pass  Ijack  of  the  inlocked  tootli  and  rest  slightly 
upon  the  labial  surfaces  of  the  adjoining  teeth,  two  short 
tubes  are  soldered  to  it,  one  at  each  end.  One  of  these  tubes 
is  set  vertically  and  the  other  horizontally.  A  piece  of  steel 
wire,  bent  at  a  right  angle  at  one  end,  and  thread-cut  and 
provided  with  a  nut  at  the  other,  is  made  to  engage  with  the 
tubes,  the  bent  end  slipping  into  the  vertical  tube  and  the 
other  passing  into  the  horizontal  one,  with  the  nut  resting 
against  its  inner  end.  By  unscrewing  the  nut  the  ends  of 
the  ribbon  are  forced  apart  and  the  desired  movements 
accomplished.     Fig.  GO  represents  the  Fig.  60. 

appliance  in  position,  and  Fig.  61  the 
separate  parts  of  which  it  is  con- 
structed. In  this  device  the  direct 
power  of  the  screw  is  used  to  furnish 
the  necessary  pressure.  Fig.  61. 

The  credit  for  first  devising  an  ap-  <mmm.,mm^ 
pliance  that  would  draw  a  tootli  out- 
ward into  line  and  at  the  same  time 
create  space  for  it  b}^  pressing  apart  the 
adjoining  teeth,  is  probably  due  to  Dr.  J.  N.  Farrar,  whose 
device  and  description  may  l^e  found  in  the  Dental  Cosmos, 
Vol.  xxvi,  page  072. 

A  lower  incisor,  Avhen  locked  inside  of  the  arch  by  the 


120 


OKTHODONTIA. 


Fk;.   G2. 


over-lapping  of  its  neighbors,  is  often  so  firmly  held  in  its 
mal-position  that  all  ordinary  means  will  fail  to  move  it 
unless  space  is  first  in'ovided  for  it  by  lateral  pressure.    This 

being  sometimes  difficult 
of  accomplishment,  the 
direct  power  of  the  jack- 
screw  may  be  taken  ad- 
vantage of  in  such  cases 
to  overcome  the  difficultv, 


Jack-Sciew  Forcing  Out  Inferior  Lateral. 


as  shown  in  Fig.  &2. 

The  patient  in  this  case 
was  at  least  twenty-five 
years  of  age  and  the  lat- 
eral incisor  tightly  in- 
locked.  A  platinum  band 
was  constructed  to  fit  the  lateral,  and  on  its  lingual  .surface 
was  soldered  a  tongue  of  heavy  platinum,  so  formed  that  it 
would  lie  in  contact  with  the  tooth  when  the  band  was  in 
position.  Into  this  tongue,  near  its  free  end,  was  drilled  a 
counter-suidc  hole  nearly  deep  enough  to  pass  through  the 
metal.  On  the  opposite  side  of  the  mouth  the  second  bicus- 
pid was  similarly  fitted  with  a  band,  to  wliich  was  soldered 
a  strijD  of  platinized  gold  long  enough  to  cover  the  lingual 
surface  of  the  adjoining  molar.  By  this  means  the  molar 
was  made  to  assist  in  resisting  the  force  to  be  applied  to  the 
lateral.  The  bicuspid  band  was  also  re-enforced  by  an 
additional  piece  of  heavy  2:»latinum  .soldered  to  it  at  a  point 
diagonally  opposite  to  the  lateral.  Into  this  latter  piece  a 
horizontal  slot  was  drilled  with  an  engine-bur,  sufficiently 
deep  and  long  to  receive  the  fish-tail  end  of  an  ordinary 
nickeled-steel  jack-screw.  After  both  l)ands  were  cemented 
in  place,  the  jack-screw  was  placed  between  them  with  the 
flat  end  in  the  l)icuspid  band  and  the  point  resting  in  the 
counter-sunk  hole  of  the  lateral  band.  The  ])atient  increased 
the  tension  of  the  screw  from  day  to  day  by  turning,  and  in 
two  weeks  time  the  tooth  was  in  line.      It  was  held  there 


PKACTICAL    TREATJ[ENT. 


121 


until  it  became  firm   by  means  of  platinum  Ijinding  wire 
woven  about  it  and  its  neighbors. 

In  the  u])})er  jaw,  where  single  incisors  stand  within  the 
arch,  they  may  be  forced  forward  into  line  by  some  of  the 
appliances  just  described  for  use  in  the  lower  jaw,  such  as 
the  Matteson  spring  and  tlie  jack-screw,  or  by  those  referred 
to  for  bringing  out  into  line  upper  teeth  during  eru])tion, 
such  as  tlie  inclined  plane,  and  the  l)and  and  bar. 

There  are  methods,  however,  of  dealing  with  cases  of  this 
character  in  adult  life,  that  are  preferable  to  those  already 
described. 

One  is  by  means  of  the  Coffin  plate  as  shown  in  Fig.  03, 
and    constructed     as     de-  yiu.  6:i 

scribed  on  page  103.  The 
advantages  of  a  plate  of 
this  character,  are  its  in- 
conspicuousness  and  great 
power.  if  Ml    iWUKKIKKKIUM      v)^ 

The  only  difficulty  in 
the  use  of  this  form  of 
Coffin  plate,  met  with  by 
the  author,  has  been  where 
the  teeth  to  be  moved, 
although  inside  of  the  arch,  stand  perpendicularly  or 
incline  slightly  forward.  In  these  cases  the  free  ends  of 
the  wires,  after  being  pressed  up  into  position  on  the  teeth, 
are  frequently  thrown  down  toward  the  cutting  edge  by  the 
force  of  the  spring  operating  upon  an  inclined  surface. 
Where  great  inconvenience  arises  from  this  cause  it  may  be 
remedied  by  cementing  a  narrow  platinum  band  about  mid- 
way of  the  crown  of  the  tooth  to  be  moved,  and  placing  the 
end  of  the  wire  spring  above  it. 

Another  plan  of  moving  outward  any  or  all  of  the  supe- 
rior incisors,  is  by  means  of  a  plate  constructed  after  the 
pattern  of  Fig.  64. 

It  is  made  of  rubber,  and  has  inserted  in  it  a  half-round 


Curtii)  Solid  Plate. 


1-2 -2 


ORTIIODOXTIA. 


gokl  wire,  with  the  Hat  side  toward  tlie  teeth.     The  wire 
Fig.  64.  passes  out  from  the  plate  on    one 

side  at  any  point  where  there 
may  be  space  for  it.  and  following 
the  outline  of  the  teeth,  but  sepa- 
rated from  them  by  a  space  of  an 
eighth  of  an  inch  or  more,  re-enters 
tlie  plate  at  some  convenient  point 
opposite.  When  in  position,  pres- 
sure is  Ijrought  to  l)ear  upon  the 
teeth  to  be  moved  by  means  of  rulj- 
l>er   bands   passing  over  the  gold 

Plate  and  Bar  «itli  Rubber  Rings.  ^yirC  and  arOUud  .SUCll  teeth. 

The  cut  shows  the  manner  in  which  these  l)ands  are  ap- 
plied. The  one  with  the  single  fold  to  encircle  the  tooth,  is 
used  where  less  traction  is  desired  ;  and  the  other,  with  the 
double  fold,  will  have  to  be  used  to  bring  the  tooth  entirely 
into  contact  with  the  wire.  To  prevent,  as  far  as  possible, 
the  bands  from  slipping  off  over  the  cutting  edges  of  the 
teeth,  the  wire  should  be  so  arranged  in  relation  to  the 
plate  that  wlien  in  po.sition  it  will  be  on  a  line  with  the  necks 
of  tlie  teetlj,  thus  enabling  the  l)ands  to  pull  u})ward  as  well 
as  outward.  Should  tlie  rul)ljer  bands  still  show  a  disinclina- 
tion to  remain  on  the  teeth,  the}'  may  be  held  in  place  by 
ligatures  tied  around  their  necks  and  secured  to  the  rubber 
on  the  i^alatine  side. 

The  jDlate  is  secured  in  position  by  beirfg  ligated  to  a 
posterior  tooth  on  each  side,  holes  being  drilled  through  the 
plate  at  points  suitable  for  the  purpose.  If,  after  the  teeth 
are  moved  out  far  enough  to  touch  the  wire,  it  be  desired  to 
move  them  still  farther,  the  bar  can  be  stretched  by  beating 
it  with  a  riveting  liammer  over  the  horn  of  a  small  anvil. 
Or,  the  wire  may  he  removed  from  the  plate  and  a  longer 
one  inserted. 

The  appliance  is  e(jually  effective  in  drawing  forward 
either  one,  two  or  all  of  the  incisor  teeth  at  the  same  time. 


PRACTICAL    TREATMENT. 


123 


Fig.  65. 


Prof.  R.  B.  Winder  suggests  the  soldering  of  small  pieces  of 
gold  to  the  how  wire  directly  opposite  each  tooth  to  be  moved, 
and  occasionally  at  intermediate  points.  By  the  aid  of  such 
cleats,  he  says,  the  rubber  ])ands  are  more  easily  attached 
and  removed,  and  traction  can  be  made  in  an  ol)lique  direc- 
tion as  well  as  forward. 

Still  another  method,  both  simple  and  effective,  of  moving 
an  incisor  outward  into  line,  is  by  a  combination  of  metallic 
screws  and  a  v  u  1  - 
canite  plate,  as  shown 
in  Fig.  65. 

A  thin  vulcanite 
plate  is  constructed 
to  cover  the  roof  of 
the  mouth  and  ca}) 
the  bic  u  s  p  i  d  s  and 
molars ;  opposite  the 
tooth  or  teeth  to  hv 
moved,  tlio  plate  is 
a  1 1 0 w e d  to  c o m e 
down  to  their  cutting- 
edges.  Directly  opposite  the  centre  of  each  of  these  teeth, 
a  hole  is  drilled  entirely  through  the  plate  to  receive  a 
piece  of  screw  wire  long  enough  to  pass  through  and 
project  a  little  beyond  it.  In  springing  the!  plate  into 
position  the  slightly  projecting  ends  of  the  screws  will  press 
against  the  teeth  and  they  will  be  moved  forward.  A  half 
turn  of  the  screws  every  day  will  soon  force  the  teeth  into 
position. 

The  originator  of  this  device  is  unknow^n,  but  it  was  first 
brought  to  the  notice  of  the  author  by  Prof.  Thos.  Fillebrown. 

Where  a  single  incisor  in  the  upper  or  lower  jaw  is 
situated  either  inside  or  outside  of  the  arch,  and  where  there 
is  room  for  its  accommodation  and  no  obstacle  exists  to 
prevent  it  from  occupying  its  normal  position,  it  may  some- 
times be  brought  into  place  by  the  simplest  of  all  means 


\'ulc;vnite  Plate  with  Screws. 


124  OETIIODONTIA. 

and    without    the   making   ov    wearing   of    any    appliance 
whatever. 

All  tliat  is  needed  is  to  instruct  the  patient  to  exert 
pressure  upon  the  tooth,  with  one  of  his  lingers  or  thumbs, 
in  the  direction  in  which  it  needs  to  go.  The  pressure  thus 
exerted  should  be  great  enough  and  continued  sufficiently 
long  to  cause  the  tooth  to  feel  uncomfortable  and  be 
re{)eated  a  half  dozen  or  more  times  daily.  The  method  is 
a  slow  one  and  somewhat  uncertain  as  the  result  will 
depend  entirely  upon  the  zeal  and  faithfulness  of  the 
patient,  but  notwithstanding  these  limitations,  it  has  been 
found  thoroughly  efficient  in  numl^erless  cases,  as  many 
practitioners  can  testify.  The  author  has  adopted  the  plan 
frequently  with  charity  patients  and  in  most  cases  with 
satisfactory  results. 

AVhen  an  incisor  tootli  in  the  loAver  jaAv  stands  outside  of 
the  arch,  the  malposition  is  usually  due  either  to  its  having 
been  forced  out  of  place  by  a  superior  one  occluding  back 
of  it,  or  to  unusual  crowding  on  the  part  of  its  neighbors. 
In  tlie  first  instance,  the  correction  of  tlie  occlusion  of  the 
superior  tooth  will  usually  press  the  lower  one  into  its 
proper  place,  while  in  the  second  instance,  it  will  be  nec- 
essary to  consider  the  advisal>ility  of  extracting  one  of 
the  crowded  teeth  to  aftbrd  room.  If  such  an  extraction 
be  deemed  best,  the  case  will  be  greatly  simplified  and 
the  mal-posed  tooth  can  l)e  brought  into  line  by  some  one 
of  the  means  shortly  to  l)e  descril)ed  for  di-awing  inward  the 
superior  incisors. 

If  it  l)e  deemed  inex2:)edient  to  extract  one  of  the  crowded 
teeth,  room  will  have  to  be  provided  either  by  expanding 
the  arch  or  by  extracting  a  tooth  or  teetli  back  of  the 
cuspids. 

In  considering  the  matter  of  ex])ansion  of  the  arch,  it 
should  be  borne  in  mind  that  tlie  enlargement  of  one  arch 
may  also  necessitate  the  expansion  of  tlie  other  in  order  to 
preserve  the  normal  occlusion.      If  both  jaws  will  admit  of 


PRACTICAL    TREATMENT. 


125 


Fig.  G6. 


it  to  advantage,  it  may  l)e  the  best  plan  to  pursiu',  altlioiigh 
it  will  necessarily  increase  the  labor  and  difticulty  of  the 
operation.  Generally,  if  the  occlusion  and  facial  expression 
be  satisfactory,  it  will  hv  far  better  not  to  disturV)  the  general 
relation  of  the  teetli,  but  rather  to  extract  one  or  more  of 
the  ].)icuspids  or  molars.  After  any  of  tlie  posterior  teeth 
have  been  extracted,  the  anterior  ones  can  be  moved  apart 
or  backward  and  the  irregular  tooth  brought  into  place.  A 
simple  and  excellent  way  of  moving  l)ackward  one  or  more 
incisors,  especially  in  the  lower  jaw, 
is  that  devised  by  Dr.  Kingsley  and 
shown  in  Fig.  66. 

The  appliance  is  a  simple  \u\- 
canite  plate  made  to  fit  the  lingual 
surfaces  of  the  ten  anterior  teeth  and 
the  adjacent  gum.  A  portion  of  the 
plate  lying  immediately  back  of  the 
tooth  or  teeth  to  be  moved  is  cut 
aw^ay  to  make  room,  and  then  slotted 
to  accommodate  the  rubber  rings 
that  are  to  act  upon  the  teeth.  By  adapting  the  diameter 
and  width  of  the  rings  to  the  force  desired,  any  degree  of 
tension  can  l;)e  Vjrought  to  bear  upon  the  outstanding  teeth. 
Any  of  the  inferior  incisors,  after  being  brought  into  line, 
will  usually  be  retained  in  place  bj^  the  occlusion  of  the 
superior  teeth,  Init  wliere  this  is  not  the  case,  they  may  be 
retained  by  means  of  platinum  binding  wire  woven  about 
all  of  the  incisors  at  or  near  their  necks,  or  they  may  be 
securely  held  ])y  means  of  a  ribbon  of  tldn  gold  fitting  the 
lingual  surfaces  of  the  incisors,  to  which  is  soldered  a 
platinum  fmnd  to  encircle  each  tooth  that  has  been  cor- 
rected. The  piece  is  set  with  phosphate  of  zinc  as  a  lining 
to  the  bands. 

For  drawing  or  forcing  into  line  any  of  the  superior 
incisors  standing  outside  of  the  arch,  a  variety  of  methods  is 
at  our  disposal.      In  the  upper  jaw  the  extraction  of  one 


Kingsley's  Vuloauite  Plate 
and  RubbLT  Bands. 


126  ORTHODONTIA. 

or  more  incisors  to  provide  room  for  other  outstanding  ones 
is,  except  in  rare  cases,  not  to  be  thought  of,  aUiiough,  as 
just  stated,  in  the  lower  jaw  extraction  may  often  be  advan- 
tageously resorted  to.  Tlic  greater  conspicuousness  of  the 
superior  incisors,  and  the  difference  in  size  between  the 
centrals  and  laterals  would  cause  the  absence  of  any  one  of 
them  to  be  most  noticeable.  Rare  cases  occur,  however,  in 
Avliich  such  extraction  is  justifiable,  as  described  on  page 
43,  but  a  wise  discrimination  must  be  exercised  in  regard 
to  the  matter,  as  otherwise  a  greater  deformity  is  likely  to  be 
created  than  the  one  already  existing.  Where  space  is 
needed  in  the  arch  for  the  outstanding  tooth  or  teeth  and 
expansion  of  the  arch  is  not  indicated,  w^e  may  obtain  it  by 
extraction  back  of  the  cuspids,  or  where  the  lack  of  space  is 
slight  in  amount  it  may  be  secured  by  simply  exerting 
pressure  upon  the  adjoining  anterior  teeth.  A  simple  way 
of  producing  this  pressure  is  by  the  use  of  compressed  wood, 
as  described  on  page  69. 

Another  plan  is  by  means  of  a  vulcanite  plate  to  which 
are  attached  gold  or  steel  wires  so  arranged  that  their  free 
ends,  when  drawn  together  and  inserted  in  the  space 
intended  to  be  widened,  will  press  the  adjoining  teeth  farther 
apart. 

Still  another,  without  the  use  of  a  plate,  wliich  tlie  author 
has  found  very  effective,  consisting  of  platinum  bands 
attached  to  the  teeth  to  be  moved,  with  a  piano-wire  spring 
acting  between  them,  is  described  and  illustrated  on  p.  161. 

Dr.  Farrar  recommends  for  the  same  purpose  a  delicate 
jack-screw  with  crutch  ends  to  fit  the  teeth  to  be  separated. 

Other  ways  of  accomplishing  the  separation  Avill  suggest 
themselves  to  an  inventive  mind. 

After  the  desired  space  has  been  obtained,  the  tooth  may 
be  brought  into  place  by  means  of  a  Coffin  plate  Avitli  a 
wire  attached  to  its  buccal  portion,  extending  forward  in  a 
curved  line  and  resting  near  its  free  end  upon  the  })roject- 
ing  toot) I.  Bending  the  wire  inward  from  time  to  time 
will  k('(!j)  uj>  the  ])ressui'('  uj)i)ii  the  moving  tooth. 


PRACTICAL    TREATMENT.  127 

To  secure  additional  power  in  such  cases,  Dr.  V.  H.  Jack- 
son* has  modified  the  above  appHance  by  inserting  two  wires 
in  the  plate,  one  on  eitlier  i^ide,  and  allowing  the  free  ends 
of  each  to  rest  upon  the  tooth  to  he  moved  as  illustrated  in 
Fig.  67.  Dr.  B.  8.  Byrnesf  presents  two  methods,  both 
simple  and  ingenious,  for  bringing  into  line  an  outstanding 

Fig.  68. 


Fig.  67 


Jackson's  Modification  of  Cottin  Plate.  Byrnes'  Baud  Regulator. 


incisor  tooth.  One,  as  shown  in  Fig.  68,  consists  of  two  gold 
or  platinum  bands  made  to  fit  suitable  posterior  teeth  intended 
for  anchorages,  and  connecting  tliem  with  a  gold  ribbon, 
nearly  long  enough  to  extend  around  the  labial  surfaces  of 
the  intervening  teeth.  At  some  point  in  the  length  of  this 
ribbon  a  gold  hook  is  soldered  to  engage  with  the  cutting 
edge  of  one  of  the  anterior  teeth  and  thus  prevent  it  from 
slipping  up  on  the  gum.  By  forcing  the  bands  over  the 
teeth  intended  to  receive  them  pressure  is  at  once  brought 
to  bear  upon  the  tooth  to  be  moved.  When  the  elasticity 
of  the  wire  has  spent  itself,  it  should  be  removed,  a  small 
piece  cut  from  its  length,  soldered  and  re-inserted.  This 
may  be  done  as  often  as  necessary  until  the  tooth  is  brought 
into  position.  Additional  pressure  may  also  be  obtained  by 
placing  pieces  of  elastic  rubber  between  the  ribbon  and  the 
moving  tooth. 

The  second  method  consists  in  making  a  band  to  fit  the 
outstanding  tooth  and  another  for  some  posterior  anchor 
tooth.     These  bands  are  connected  by  a  strip  of  thin  cor- 

*  DenM  Cosmos,  Vol.  XXX,  p.  510. 

t  DenM  Cosmos,  Vol.  XXVIII,  p.  278. 


128 


OETHODOXTIA. 


nigated  gold  plate.  When  ready  for  use  the  hands  are 
slipped  over  their  respective  teeth  and  traction  is  exerted 
by  the  elasticity  of  the  corrugated  metal.  Tlie  closeness  of 
the  corrugations  will  regulate  the  force  desired,  which  may 
be  increased  at  will  by  pressing  the  folds  closer  together. 
Fig.  69  shows  the  appliance  in  position. 

The  author's  usual  plan  in  such  cases  is  to  solder  pins  or 

hooks  at  suitable  points  on  the  two  bands  and  cement  the.se  in 

position.   They  are  then  connected  by  means  of  a  rubber  band 

Fig.  69.  extending    from 

tooth  to  tooth  and 
caught  over  the 
projections  on  the 
bands  as  shown  in 
Fig.  70. 

By  cutting  the 
rubber  Ijands  from 
French  rubber 
tubing  of  different 
dia  meters,  any 
amount  of  tension 
may  be  produced. 
Dr.  Kingsley* 
has  suggested 
another  method 
of  producing  the 
same  result  by  the 
combination  of 
gold  wires  with  a 
rubber  plate  as 
shown  in  Fig.  71. 
One  end  of  the 
long    wire   is   im- 

Magill  B.inds  and  Rubber  Riugs  lor  drawing  in  Central.  1 )  C  d  d  C  d      in      t  ll  C 

plate  while  the  other  is  converted  into  a  hook.  A  short 
wire  similarly  shaped  and  secured  passes  between  certain 

*  Oral  Deformiti&s,  p.  87. 


Bvm.>.'s'  Cornigated  B:uid. 


PltACTlCAL    Ti;  KATM  KXT. 


129 


Fiu.  71. 


posterior  teeth  on  the  opposite  side  and  eonies  forward  to 
nearly  meet  the  first  one.  By  connecting;-  the  two  with  a 
rubber  l)an(b  ])ressure  is  bronolit  to  l)eai'  upon  the  ])ro]n- 
inent  tooth  wliich  is  oraihially  forced  inward  into  hue. 

.\nother  method  of  ])r.  I\in,ijjsh\y's  foi'  ])rcssin<;- in  one  or 
more  of  the  anterior  teeth  is  shown  in  Fig.  72.  It  consists  of  a 
rul)ber  phite  with  gohl  1)ow- 
spring  attaclied. 

He  says  :*   "  The  })hite  was 
accurately  adjusted  to  fit  and 
catch  between  the  bicuspids 
and  molars.      The  gold  wire 
in    front    was    elastic     a  n  d 
springy.       It  was  l^ent  so  as 
to  impinge  upon  the  incisors 
(or  incisor),  then  cauglit  in 
front  of  them,   pulled  back, 
and  sprung  into  place.      As 
fast    as    the    reduction    '\\'as 
accomplished,  the  wire 
was  bent   at   the  sides 
where    the    teetii    had 
been  extracted,  and  also 
contracted." 

Protrusion  of  a  single 
incisor  or  more  may 
also  be  corrected  by 
means  of  a  fixed  ap- 
pliance with  the  screw 
as  the  operating  prin- 
ciple, as  in  the  methods 
of  Drs.  Patrick  and 
Farrar. 

In  using 'the  Patrick 
appliance  for  irregu- 
larities of  this  character, 


Kingsley  Plate. 


Fro. 


Kingsley  Plate. 


Idem,  p.  109. 


130  ORTHODONTIA. 

the  adjustable  loop-bands  and  bow-spring  are  placed  in 
position  and  properly  secured.  The  slide  "  H  "  is  then 
made  to  rest  against  the  projecting  tooth,  the  hook  "'  I "' 
is  caught  over  the  cutting  edge  of  some  adjoining  tooth 
and  tension  is  produced  bv  turnino;  the  screws  ''  D."  (See 
p.  85.) 

Superior  incisor  teeth,  after  being  forced  backward  into 
line,  may  be  retained  most  simply  by  means  of  the  platinum 
band  and  gold  bar  as  shown  in  Figs.  13  and  14.  (pp.  79 
and  80.) 

It  is  inconspicuous,  occupies  little  space,  and  holds  the 
tooth  or  teeth  immovably. 

When  sufficient  time  has  been  allowed  for  the  tooth  to 
become  firm,  (never  less  than  six  months)  the  retainer  should 
be  carefully  removed  as  described  on  i:)age  91.  For  a  few 
months  afterward  the  patient  should  be  seen  once  a  week, 
in  order  to  ascertain  whether  the  tooth  is  remaining  in  its 
new  position.  Should  it  manifest  a  tendency  to  recede,  the 
retainer  must  again  be  placed  in  position  and  kept  there  for 
a  further  j^eriod  of  three  months  or  more. 

By  thus  carefully  watching  a  case  after  its  .supposed  com- 
pletion, we  may  often  avoid  the  loss  of  some  of  the  ground 
we  have  gained. 


CHAPTER   IV. 

CUSPID  TEETH  SITUATED   OUTSIDE  OR   INSIDE  OF   THE  ARCH. 

Of  the  various  forms  of  irregularity  tliat  present  for  treat- 
ment, none  perhaps  is  more  common  than  that  in  which  the 
cuspid  teeth  are  located  outside  of  the  arch.  The  cause 
most  frequently  responsible  for  this  condition  is  the  prema- 
ture extraction  of  the  temporary  cuspids,  altliough  it  is  often 
caused  by  delayed  eru])tion  of  the  permanent  ones,  and  by 
the  lack  of  accommodation  a  small  arch  sometimes  affords 
for  the  full  complement  of  teeth.  The  cuspids  (superior) 
being  among  the  later  teeth  to  a})pear,  often  find  their  terri- 
tory pre-occupied  by  the  earlier  arrivals.  Frequently,  though 
not  always,  the  mal-position  of  the  cu.spids  is  associated  with 
like  mal-position  of  certain  neighbors,  usually  the  central 
and  lateral  incisors.  The  irregularity  of  these  adjoining 
teeth  is,  in  most  cases,  brought  about  by  the  pressure  of  the 
cuspids  in  their  attempt  to  occupy  their  places  ;  for,  previous 
to  their  appearance  there  is  no  inducement,  if  the  occlusion 
be  normal,  for  the  incisors  to  vary  much  from  their  true 
positions.  The  fact  should  not  be  overlooked  that  all  teeth 
in  erupting,  are  impelled  by  a  strong  hidden  force  to  seek 
their  proper  positions  in  the  line  of  the  arch,  and  in  no 
teeth  is  this  persistence  more  plainly  or  powerfully  exhibited 
than  in  the  cuspids. 

The  conditions  being  favorable  each  tooth  will  naturally 
assume  its  place  in  line,  and  should  obstructions  interfere 
it  will  strive  to  overcome  them ;  but  the  cuspid  teeth  will,  if 
necessary,  exert  a  power  far  exceeding  that  of  any  of  the 
other  teeth  in  their  efforts  to  gain  their  proper  positions  in  the 
arch.  To  this  end  incisors  are  often  disarranged,  and  bi- 
cuspids forced   inward  or  outward.     This  wonderful   force 

(131) 


132  oirrnoDOXTiA. 

exerted  by  tlie  cuspids,  may  well  be  illustrated  by  a  case 
which  occurred  in  the  practice  of  the  author  many  years 
ago  :— 

The  patient  was  a  young  lady  about  fifteen  years  of  age, 
in  whose  upper  jaw  a  cuspid  had  erupted  outside  of  the  arch, 
causing  projection  of  the  lip.  All  of  the  other  teeth  were 
regular,  ])ut  the  Ijieuspids  and  molars  on  the  affected  side 
were  somewhat  in  advance  of  their  true  positions,  and  there 
was  eonse(|uently  very  little  space  in  the  arch  for  the  accom- 
modation of  this  cuspid.  The  first  molar  on  the  same  side 
was  badly  decayed,  so  it  was  decided  to  extract  it  as  a  pre- 
liminary to  making  room  for  the  cus})id.  An  appliance  was 
then  attached  to  the  second  molar  and  second  bicuspid,  in- 
tended to  draw  the  latter  tooth  l^ackAvard.  The  patient  left 
wath  this  fixture  in  position  and  did  not  return  until  eight- 
een months  later,  when  it  was  noticed  that  both  bicuspids 
had  moved  backward  and  the  cuspid  occupied  its  normal 
position  in  the  arch.  It  transpired  that  the  appliance,  having 
caused  some  pain,  was  removed  by  the  patient  two  days  after 
it  had  Ijeen  placed  in  })osition.  The  correction  of  the  irregu- 
larity had  been  entirely  accomplished  by  the  cuspid  forcing- 
its  way  into  place  and  crowding  the  bicuspids  backward  in 
the  effort. 

To  obtain  space  for  the  accommodation  of  the  cuspids  when 
they  are  situated  outside  of  the  arch,  we  usually  have  to 
decide  between  the  enlargement  of  the  arch  and  the  extrac- 
tion of  one  or  two  teeth  posterior  to  them.  If  the  upper 
arch  is  contracted  and  will  admit  of  expansion  to  advan- 
tage, it  may  be  done  by  one  of  the  methods  described  in 
Chapter  A^IT.  of  this  part;  l)ut  if  this  l»e  not  indicated,  we 
will  have  to  decide  upon  the  extraction  of  a  bicus])id  or 
molar  in  order  to  obtain  space. 

A  careful  consideration  of  tlic  rules  governing  extraction, 
on  pages  45  and  46,  will  greatly  assist  tlie  ()})erator  in 
deciding  which  tooth  to  extract. 

It  very  frequently  happens  that   the  space  in  the  arcli  in- 


PRACTICAL    TKEAT.M ENT. 


Fig.  73. 


tended  to  accommodate  the  cuspid  is  nearly,  but  not  quite, 
sufhcient.  In  such  cases,  slight  additional  space  may  gen- 
erally be  gained  l)y  pressing  apart  the  adjoining  teetli  with 
the  tixture  shown  on  page  lOl. 

Room  having  been  provided,  the  cus})id  tooth  may  be 
l)rought  into  place  by  one  of  several  methods  that  are  equally 
effective  in  the  ui)per  and  lower  jaws.  Outstanding  cuspids 
are  usually-  situated  a  little  in  advance  of  their  normal  posi- 
tions, so  that  in  bringing  them  to  place  we  must  exert  force 
in  a  backward  as 
well  as  inward  direc- 
tion. Dr.  Kingsley, 
in  his  work,*  shows 
a  neat  and  etfective 
appliance  for  l)ring- 
ing  inferior  cuspids 
into  line.  It  is  illus- 
trated in  Fig.  73. 

It  consists  of  a  nar- 
row vulcanite  })late, 
fitted  to  the  lingual 
surftices  of  the  teeth 

and  the  adiacent  DOr-  Klngsley's  vulcanite  Plate  and  Rubber  Bands. 

tion  of  the  ridge.  In  the  posterior  portion  of  the  plate,  gold 
hooks  are  inserted  over  which  rubber  rings  are  caught, 
drawn  forward  and  tied  to  the  cuspids. 

Another  simple  way  of  bringing  about  the  same  move- 
ment, is  by  means  of  the  Coffin  plate  with  the  wire  or  wires 
attached  to  the  buccal  portion  and  extending  forward  until 
their  free  ends  rest  upon  the  teeth  to  be  moved.  Ordinarily^ 
the  pressure  to  be  exerted  by  them  would  be  inward  only ; 
but  by  bending  their  ends  into  the  form  of  partial  hooks,  so  as 
to  engage  with  the  mesial  surfaces  of  the  teeth,  an  additional 
backw^ard  pressure  is  obtained. 

Sometimes  a  cuspid  may  be  drawn  into  position  by  so 
simple  a  means  as  that  shown  in  Fig.  74. 

*Loc.  cit. 


134 


ORTHODONTIA. 


Incieaseil  \ui  liuiasre 


In  this  case  a  platinum  band,  with  a  pin  on  its  labial  face, 
was  cemented  to  the  outstanding  cuspid.     To  the  iirst  bicus- 
FiG  74.  i^id  on  the    opposite    side 

was  fitted  a  similar  band 
with  a  small  gold  hook  on 
the  palatine  surface  and 
a  bar  of  platinized  gold  on 
the  buccal  surface  long- 
enough  to  extend  to  and 
rest  upon  the  adjoining- 
cuspid  and  second  bicus- 
pid. This  provided  the 
resistance  of  three  teeth, 
whilst  attachment  was  made  to  but  one.  A  light  vulcanite 
plate  was  made  to  cover  the  arch,  so  as  to  protect  it  from 
the  irritation  of  the  rubber  ring,  which  was  stretched  from 
band  to  band.  The  operation  of  bringing  the  tooth  into 
line  was  somewhat  slow,  occupying-  some  four  or  five  weeks 
time,  but  the  object  was  satisfactorily  accomplished. 

In- most  cases,  however,  greater  force  than  that  exerted  by 
a  rul)ber  band  will  Ije  necessar}^  to  draw  a  cuspid  into  place, 
especially  if  it  be  large  and  firmly  implanted.  In  such 
event  the  power  exerted  by  a  screw,  in  some  form,  will  prob- 
ably yield  the  best  results. 

Fig.  To  rei^resents  a  case  of  this  character,  where,  in  addi- 
tion to  the  firmness  of 
the  tooth,  the  patient  re- 
sided at  such  distance 
from  the  dentist  that  a 
visit  to  him  could  be 
made  only  at  intervals  of 
two  or  tlu'ee  weeks.  It 
^vas  tlierefore  necessary 
t(j  devise  an  appliance  of 
such  character  that  it 
could  not  be  removed  or 

Gold  Box  and  Screw  L'rawint;  in  Cuspid.         misplaCCd,     and      witll     a 


I'RACTICAL    TREATMF:NT. 


135 


sufficiency  of  power  that  might  l)o  regulated  by  the  patient 
herself.  The  a})pliance  sliowu  in  cut,  consists  of  two  plati- 
num l)an(ls  made  to  tit  the  misplaced  cuspid  and  opposite 
molar  respectively,  and  cemented  to  these  teeth.  To  the 
palatine  surface  of  each  of  these  bands  was  soldered  a  gold 
ring,  which  served  as  point  of  attachment  for  the  gold  box 
and  screw,  which  operated  between  them. 

One  end  of  the  gold  Ixjx  was  l)ushed  and  thread-cut  to 
receive  the  gold  screw,  which  at  the  opposite  end  was  bent 
into  the  form  of  a  hook  to  engage  with  the  ring  on  the  cus- 
pid band.  The  other  end  of  the  box  was  fitted  with  a  smooth 
gold  wire,  with  a  head  on  one  end  to  serve  as  a  swdvel, 
and  a  hook  on  the  other  to  attach  to  the  ring  on  the  molar 
band.  Turning  the  box  with  a  wrench  drew  the  screw  in- 
w^ard,  and  with  it  the  cuspid  tooth.  Using  a  single  molar 
as  anchorage  in  the  movement  of  a  cuspid  was  scarcely  in 
accord  with  correct  practice,  but  in  this  case  there  was  no 
alternative.  In  drawing  the  cuspid  to  place  the  molar  was 
also  moved  somewhat  inward  and  forward,  l)ut  it  soon 
resumed  its  former  j^osition  after  l^eing  relieved  from  duty. 
The  corrected  tooth  was 
retained  in  place  by 
having  cemented  to  it 
the  small  band  and  bar 
appliance  shown  in 
position  and  separate  in 
Fig.  76. 

The  tooth  in  the  })re- 
ceding  case  was  retained 
in  the  same  manner. 
Six  months  sufficed  for 

each  tooth  to  o'rO^\'  firm  completed  case  with  Retaiuing  Appliance. 

in  place.  Quite  frequently  a  cuspid  tooth  is  located  so  far 
anteriorly  to  its  proper  place  that  the  principal  movement 
required  of  it  is  in  a  backward  direction.  To  effect  this  move- 
ment Dr.  Farrar  makes  use  of  his  device,  as  illustrated  in 


Fig.  76. 


13G 


OKTIIODUNTIA. 


Farrai's  Tractimi  Apparatus. 


Fig.  77.     It  consists  of  a  narrow  ribbon  of  ,ii,'ol(l,  lon<>;  enough 
to  enclose  the  cuspid  tooth  and  some  tootli  l.)ack  of  tlie  space 

it  is  to  occui)v. 
The  ends  of  this 
ribbon  n  e  a  r  1  y 
meet  on  the  buccal 
side  of  the  teeth, 
and  after  being  re- 
enforced  with 
studs  of  heavy 
gold,  the  anterior 
one  Ijeing  simply 
drilled  and  the 
posterior  one  drill- 
L'(l  and  threaded, 
tliey  are  connected 
1  )y  means  of  a  gold 
screw.  The  turn- 
ing of  tlie  screw  brings  the  ribbon  ends  nearer  together,  and 
causes  corresponding  traction  on  the  misplaced  tooth.  The 
ribbon,  at  suitable  places,  has  ears  or  tips  attached  to  it,  in- 
tended to  rest  upon  the  masticating  or  inclined  surfaces  of  the 
enclosed  teetli  and  prevent  the  band  from  slipiiing  u})  and 
irritating  tlie  gum.  Dr.  Patrick's  ai)pliance,  as  shown  in 
Fig.  22,  is  also  well  adapted  to  produce  backward  movement 

of  a  cuspid  or  other  tooth. 
Prof.  Angle  a  c  c  o  m  - 
plishes  the  same  result 
by  means  of  bands,  tubes, 
traction  screw  and  nut,  as 
described  and  illustrated 
on  ])age  iXJ. 

The  author's  device  for 
the  backward  movement 
of  teeth  is  shown  in  Fig. 
7'S.      It   does    not    involve 

AiUhor-8  Appliance  lor  Retrnctioii.  ,],,,     niakin!'-    or     USe    of    a 


rRACTICAl.    TRKATMENT. 


137 


Fiff.  79. 


plate,  screws  or  nuts,  and  is  very  simple  in  design  and  con- 
strnction.  A  platinum  band,  with  short  gold  wires  soldered 
to  the  buccal  and  lingual  surfaces,  is  cemented  to  the 
tooth  to  be  moved,  while  a  similar  one  is  attached  to  a 
molar  or  other  anchor  tooth.  The  wires  on  the  anterior 
band  are  bent  forward,  and  those  on  the  posterior  one 
are  curved  backward.  Two  rubber  rings,  cauglit  over 
the  gold  hooks,  connect  the  two  bands  and  vield  the  tractile 
power  recpiired.  These  rubber  rings  can  be  removed  and 
replaced  for  cleansing  the  teeth,  or  can  be  renewed  at  will 
by  the  patient.  Two  rings  can  be  attached  to  each  pair  of 
hooks,  if  greater  power  be  retpiired,  or  the  same  object  can. 
be  attained  by  cutting  wider  rings  from  thicker  tubing. 

Prof.  E.  T.  Darby's  plan  for  producing  the  same  movement 
is  by  the  use  of 
a  rubber  plate, 
a  gold  encase- 
ment for  the 
cuspid,  and  a 
gold  screw  for 
connecting  the 
two  and  produc- 
ing the  required 
tension.  Fig.  79 
is  drawn  from 
one  of  his 
models,  and  re-  ''''''''''  ^■"''""'" '"'  R*^"-*^«°"- 

presents  the  fixture  in  position.  The  case  was  that  of  a 
young  lady,  fourteen  years  of  age,  who  applied  for  the  cor- 
rection of  irregularity  of  the  anterior  teeth.  As  will  be 
noticed  in  the  illustration,  both  laterals  and  the  right  cen- 
tral were  inside  of  the  proper  line  of  the  arch,  while  the  left 
central  was  outside  of  it.  Space  was  needed  to  bring  these 
teeth  into  position,  and  to  obtain  it  the  left  cuspid  had  to  be 
moved  backward  in  the  arch.  Op})ortunity  for  so  doing  was 
afforded  by  the  absence  of  the  first  bicuspid. 


138 


ORTllorx^XTIA. 


To  move  tlie  cuspid  backward,  and  to  assist  in  accomplish- 
ing other  movements,  a  rub])er  plate  covering  the  arch  and 
capping  the  molar  teeth  was  constructed,  and  into  it  on  the 
buccal  surface  was  inserted  a  gold  stud  or  ear,  drilled  and 
tapped.  A  gold  helmet,  to  cover  the  entire  crown  of 
the  cuspid  was  then  constructed,  with  a  i^rojection  on  the 
labial  .surface  drilled  for  the  passage  of  the  traction  screw. 
After  this  helmet  was  cemented  in  place  with  phosphate  of 
zinc,  and  the  plate  inserted,  the  two  were  connected  by  means 
of  a  long  gold  screw.  Twice  each  day  this  screw  was  turned, 
until  the  cuspid  was  brouglit  almost  in  contact  witli  the 
second  bicuspid. 

While  this  movement  was  j^rogressing,  other  objects  were 
being  accomplished.  The  rubber  plate  when  first  inserted, 
had  a  piano  wire  spring  attached  to  its  palatine  surface,  to 
force  forward  the  right  central.  This  accomplished,  the 
spring  was  removed  and  rubber  added  to  the  plate,  to  keep 
this  tooth  in  its  new  position.  Two  new  piano  wire  springs 
were  next  inserted,  to  spread  apart  and  press  forward  the 
laterals,  as  shown  in  cut.  They  were  brought  into  posi- 
FiG.  80.  tion  by   the   time 

the    cuspid    had 
been  drawn  suffi- 
ciently backward. 
J  \  The  helmet  and 

^  screw  were  now  re- 

z.^  moved  and  a  piece 

of  piano  wire, 
doubled  and  bent 
to  proper  shape, 
(  was  inserted  in  the 
''N:Ti?r^/  hole  of  the  gold 
stud  in  the  rubber 
plate,  in  such  a  way  that  the  folded  end  would  rest  upon  the 
outstanding  central  and  force  it  into  line. 

The  case  as  corrected  is  .shown  in  Fig.  80.      The  entire 


\ 


Corrected  Case. 


TRACTICAL    TREATMENT.  139 

Avork  of  cori'ec'tioii,  with  its  varied  movements  occupied 
but  five  montlis  time,  and  was  accomplished  by  the  use  of 
a  single  plate  with  it^  different  attachments.  To  retain  the 
teeth  in  position,  a  rul>l)er  }>late  was  worn,  covering  the 
arch  and  having  a  gold  T  inserted  to  pass  between  the 
centrals. 

When  a  su})erior  cuspid  erupts  inside  of  the  arch,  the 
difficulties  attending  its  being  brought  into  position  are  far 
greater  than  when  it  eruj^ts  externally.  This  is  partly  due 
to  the  fact  that  the  space  between  it  and  the  opposite  side  of 
the  arch  is  sometimes  too  limited  to  admit  of  the  use  of 
some  of  our  best  power-producing  appliances,  and  partly 
also  to  the  amount  of  alveolar  process  that  will  have  to  be 
resorbed  before  the  tooth  can  assume  its  i)roper  position. 

The  power  to  be  applied  to  an  in-lying  cuspid  to  force  it 
outward  must  necessarily  l)e  very  great  to  carry  with  it  an}^ 
prospect  of  success.  A  solid  Coffin  plate  with  a  very  stiff 
piano  wire  imbedded  in  it  will  yield  the  greatest  amount  of 
spring  power,  and  where  this  proves  insufficient,  we  must 
needs  resort  to  the  jack-screw  in  some  of  its  forms.  The 
ordinary  jack-screw,  applied  between  Magill  ])ands,  some- 
what after  the  manner  illustrated  in  Fig.  62,  has,  in  the  au- 
thor's hands,  accomplished  the  best  results  in  such  cases. 


CHAPTER  V. 

MISPLACED  BICUSPIDS. 

The  bicuspid  teeth,  both  superior  and  inferior,  are  often 
found  located  outside  or  inside  of  the  normal  arch  line,  but 
their  mal-position  is  not  of  as  frequent  occurrence  as  that  of 
the  anterior  teeth. 

Their  position  out  of  line,  as  in  the  case  of  most  forms  of 
individual  irregularity,  is  due  to  lack  of  space,  or  the  crowd- 
ing of  other  teeth.  Sometimes,  through  tardy  eruption,  their 
space  in  the  arch  has  been  encroached  upon  by  the  pressure 
of  the  erupting  cuspids  in  front,  as  well  as  the  forward-moving 
tendency  of  the  molars.  In  such  cases,  one  or  both  of  the 
bicuspids  are  compelled  to  assume  a  position  outside  or 
inside  of  the  arch,  the  latter  being  the  one  they  most  com- 
monly take. 

Again,  their  predecessors,  the  deciduous  molars,  frequently 
have  their  crowns  destroyed  by  caries  long  l^efore  the  time 
for  their  natural  removal,  while  their  roots  remain.  Induce- 
ment is  thus  offered  to  the  adjoining  teeth  to  occupy  part  of 
the  space,  and  the  l)icuspids  are  forced  to  erupt  in  an  abnor- 
mal position. 

In  other  cases,  they  may  have  taken  their  places  in  line, 
f)r  nearly  so,  and  are  sul)se(|uently  forced  out  of  place  by  the 
effort  of  the  cuspids  to  occui)y  their  places  in  the  arch.  Tlio 
ease  with  which  they  may  be  forced  out  of  position  is  readily 
understood  when  we  consider  that  their  roots  are  conical  and 
rather  short,  and  that  they  are  i)laced  between  teeth  that  are 
firmly  set  and  have  either  a  single  long  root  firmly  implanted, 
like  the  cuspids,  or  several  roots,  like  the  molars.    Their  dis- 

(140) 


PRACTICAL    TREATMENT.  141 

tinctly  convex  approxinial  surfaces  also  greatly  favor  their 
displacement. 

The  second  bicusjdd  is  more  frequently  found  out  of  line 
than  the  iirst,  probably  because  of  its  later  erui)tion. 

The  lack  of  alignment  of  one  or  both  bicuspids  is  some- 
times associated  with  a  greater  or  less  degree  of  torsion  ;  but 
this  is  not  of  common  occurrence,  and  when  met  with  is 
either  corrected  in  the  act  of  bringing  the  tooth  into  line,  or 
will  have  to  be  remedied  by  a  separate  operation  afterward. 

The  greater  or  less  difficulty  of  bringing  into  line  one  or 
more  bicusi)id8  situated  inside  of  the  arch,  will  usually  be 
entirely  dependent  upon  the  amount  of  space  existing  for 
their  accommodation.  If  much  of  their  space  in  the  arch 
has  been  pre-occupied  by  adjacent  teeth,  these  will  first  have 
to  be  pressed  apart  to  afford  accommodation.  Should  full 
or  nearly  full  space  exist  for  them  in  the  arch,  they  may 
"usually  be  forced  into  line  by  the  elasticity  of  a  vulcanite 
plate,  or  of  metal  in  some  form  of  spring.  Where  it  is  de- 
signed that  the  moving  tooth  shall  make  room  for  itself 
as  it  advances,  the  greater  power  of  the  jack-screw  will  be 
required. 

A  simple  method  of  moving  a  bicuspid,  either  upper  or 
lowTr,  outward  into  line,  is  to  obtain  a  |)laster  model  of  the 
jaw.  The  plaster  tooth  representing  the  one  to  be  moved, 
should  then  be  cut  away  on  its  2>alatine  or  lingual  surface, 
until  this  portion  of  it  is  in  line  with  the  same  surfaces  of 
the  adjoining  teeth.  A  vulcanite  plate  made  upon  this 
model,  w4th  a  piece  of  piailo  wire  imbedded  in  its  central 
portion,  if  it  be  for  the  lower  jaw,  will,  by  its  elasticity,  soon 
bring  the  tooth  into  position.  Or,  we  may  make  the  plate 
upon  the  unaltered  model,  and  then  insert  a  wooden  peg  in 
a  hole  drilled  in  the  plate  opposite  the  tooth  to  be  operated 
upon.  Or,  instead  of  the  wooden  })eg,  a  metal  screw  may  be 
inserted  so  as  to  act  upon  the  tooth.  By  setting  the  screw 
well  into  the  rubber  plate,  it  may  be  elongated  by  turning 
from  time  to  time  until  the  object  is  attained. 


142 


OETHODONTIA. 


Fig.  81. 


Talbot's  Vulcanite  Plate  and  Coiled  Spring 


Fig.   82. 
A 


Dr.  Talbot  lias  devised  an  excellent  method  of  forcing  one 
or  more  bicuspids  into  line  by  means  of  a  coiled  spring  of 

piano  Mire,  in  connec- 
tion with  a  rubber  plate 
to  hold  it  in  po.sition 
and  properly  direct  its 
action.  Fig.  81  repre- 
sents the  appliance  in 
position.  Dr.  Talbot 
says :  *  "A  thin,  narrow, 
close-fitting  vulcanite 
plate  was  made,  and  a 
hole  drilled  through  the 
middle  of  it,  opposite  the  centre  of  the  tooth  to  be  moved. 
In  the  other  side,  another  hole  was  drilled,  but  not  quite 

through  the  plate.  A  suitable  spring, 
Fig.  82,  was  then  made  of  piano  wire, 
having  a  single  coil  A,  and  the  ends 
of  its  arms  bent  at  about  a  right  an- 
gle. One  of  these  ends,  C,  was  cut 
short  to  enter  the  corresponding  hole 
in  the  plate,  and  the  other  end,  B, 
left  long  enough  to  go  through  the  plate  and  impinge  on  the 
lingual  surface  of  the  bicuspid,  leaving  a  full  eighth  of  an 
incli  between  that  arm  of  the  spring  and  the  plate,  as  is 
clearl}'^  shown  by  Fig.  81,  where  the  .spring  is  in  position  to 
act  upon  the  tooth  to  be  moved.  Both  the  .spring  and  the 
plate  may  be  removed  instantly,  either  for  cleansing  pur- 
poses or  to  increase  the  power  of  the  spring  by  spreading  its 
Pj^   ^  arms,  or  to  open  the  coil  so  that  the 

tooth  may  be  held  steady  at  the 
point  to  which  it  may  have  been 
moved.  Fig.  83  .shows  a  spring 
having  two  long  ends,  B  B,  which 
coikd  Spring.  |^  dcsigucd  for    a  case  in    which 

two  such  teeth  are  to  be  moved  in  opposite  directions." 

*  Dental  Cosmon,  Vol.  XX  VIII,  pp.  S-fi-T. 


../\.. 


Coiled  Spring. 


PEACTICAL    TRKATM  KXT. 


143 


In  eases  wliere  the  .suj)erior  power  of  the  jack-screw  is  to 

be  taken  advantage  of,  Dr.  Kingsley's  method  of  using  it  in 

combination   with    a 

1    , ,    1  1  •  ,  Fig.  84. 

slotted   V  n  1  c  a  n  1 1  e 

plate,  is  certainly  one 

of  the  best. 

The  accompanying 

illustrations.  Figs.  84, 

85  and  86,  c  o  p  i  e  d 

from   Dr.  Kingsley's 

work,*    represent 

some  of  the  ways  in 

which    he   a  c  c  o  m  - 

plishes  movements,  slightly  varying  in  character.     Fig.  84 

was  used  to  move  outw^ard  a  left  superior  second  bicuspid ; 

Fig.  85  operated  to  move  outward  both  bicuspids  of  the  left 


Fig.  86. 


Fig.  85. 


Kingsley's  Slotted  Vulcanite  Plates  with  Jaok-Screw. 

side  inferior,  the  first  more  than  the  second  ;  while  Fig.  86 
moved  all  four  of  the  inferior  bicuspids. 

A  jack-screw  should  not  rest  against  and  operate  upon 
naked  teeth  for  evident  reasons,  but  Avhere  it  is  desired  to 
avoid  the  use  of  a  plate,  Magill  bands,  re-enforced,  drilled 
and  counter-sunk,  may  be  cemented  to  the  teeth  to  be  moved 
and  the  jack-screw  inserted  between  them.      Prof.  Angle's 

*  Loc.  cit. 


144  ORTHODONTIA. 

device  for  expanding  the  arch,  as  shown  and  described  on 
page  99,  may  also  be  advantageously  used  for  moving  out- 
ward one  or  more  of  the  bicuspids.  It  will  be  noticed  that 
in  the  operation  of  this  appliance  any  instanding  teeth  are 
moved  outward  into  line  before  real  expansion  of  the  arch 
begins:  if  therefore,  the  moving  of  individual  teeth  is  alone 
desired,  operations  can  be  suspended  as  soon  as  that  object 
is  accomplished. 

The  small  size  of  the  jack-screw  in  the  Angle  device  is 
also  an  element  in  its  favor,  since  it  will  interfere  less  with 
the  movements  of  the  tongue  than  the  larger  ones  commonly 
used. 

In  addition  to  the  power  of  the  jack-screw,  it  has  the 
further  advantage  of  rapidity  of  action  ;  so  that,  if  its  posi- 
tion in  the  mouth  should  somewhat  inconvenience  the 
patient,  it  would  do  so  only  for  a  very  short  time. 


CHAPTER   VI. 

TORSION. 

The  term  torsion,  as  applied  to  the  teeth,  signifies  that 
condition  in  which  a  tooth  is  found  to  be  turned  upon  its 
axis.  Rotation  refers  to  the  act  of  twisting  or  turning  a 
tooth  so  as  to  bring  it  into  normal  position.  Torsion,  there- 
fore, describes  the  condition,  and  rotation  the  operation. 

Torsion  is  usually  due  to  some  abnormal  influence  opera- 
tive before  or  during  eruption.  Lack  of  space  will  often 
impel  a  tooth  during  eruption  to  turn  in  such  a  way  as  to 
present  its  smaller  diameter  toward  the  space  intended 
for  its  accommodation,  in  order  to  occupy  that  space  at 
all.  A  root,  or  even  a  portion  of  one,  will  also  often  cause 
a  tooth  to  partly  turn  in  its  socket  while  seeking  its  position 
in  the  arcli.  Torsion  of  the  superior  central  incisors,  so  often 
met  with,  is  doubtless  due  in  the  majority  of  cases  to  undue 
thickness  of  the  median  alveolar  septum.  The  condition  is 
also  produced  after  eruption  by  the  crowding  of  adjoining 
teeth,  induced  by  some  unusual  pressure,  such  as  the  effort 
of  a  later  erupting  tooth  to  occupy  its  place  in  the  arch. 

Torsion  is  met  with  in  all  degrees  of  extent,  from  the 
slightest  prominence  of  one  corner  of  a  tooth  to  a  complete 
half-turn. 

It  occurs,  generally,  in  single  rooted  teeth,  or  in  those  with 
a  slightly  bifurcated  root ;  and  among  these,  those  with  roots 
most  nearly  round  are  the  ones  commonly  affected  on 
account  of  the  ease  with  which  they  can  be  made  to  turn 
upon  their  axes. 

At  times  cases  are  met  with  in  wdiich  two  adjoining  teeth 
are  thus  affected,  usually  each  in  like  degree,  this  variety  of 
the  condition  being  known  as  Douljle  Torsion. 

(145) 


140  ORTHODONTIA. 

Rotation  is  usually  not  a  very  diflieult  ()i)ei'ation  in  itself, 
but  when  complicated  liy  the  crowd iiii:;  or  disarrangement 
of  adjoining  teeth  it  sometimes  proves  (juitc  troublesome. 

Where  there  is  sufficient  space  m  the  arch  to  accommodate 
the  tooth  after  it  has  been  turned,  we  have  simply  the  mat- 
ter of  rotation  to  deal  with  :  but  when  such  is  not  the  case, 
our  first  efforts  must  be  directed  toward  providing  space. 
This  may  be  done,  if  the  deficiency  be  slight,  by  pressing 
apart  the  impinging  teeth  by  some  of  the  means  described 
on  page  40 ;  but  where  great  space  needs  to  be  provided,  and 
expansion  of  the  arch  is  not  indicated,  it  will  be  necessary 
to  extract  some  less  important  tooth  to  afford  opportunity 
for  bringing  the  turned  tooth  into  line.  In  the  case  of  teeth 
with  flat  crowns,  as  the  incisors,  we  may  adopt  either  of  two 
plans  for  turning  the  tooth,  viz.:  grasping  the  crown  through- 
out its  entire  circumference  and  applying  suitable  power,  or 
by  direct  pressure  upon  one  or  both  of  the  angles  that  are 
out  of  line.  With  teeth  having  round  crowns,  such  as  the 
cuspids,  we  are  limited  to  the  plan  of  making  attachment  to 
the  periphery  of  the  crown. 

At  one  time  it  was  difficult  if  not  almost  impossible  to 
grasjj  a  tooth  so  securely  as  to  have  the  attachment  resist  tlie 
strain  of  the  applied  power,  but  since  the  introduction  of 
the  Magill  band  this  greatest  of  all  difficulties  associated 
with  rotation  has  been  overcome. 

One  of  the  simplest  and  most  eff'ectual  methods  of  rota- 
ting a  flat-crowned  tooth  is  by  the  use  of  a  rubber  plate 
made  to  cover  the  palate  and  envelope  the  posterior  teeth  on 
either  side,  according  to  the  CoHin  plan.  To  the  palatine 
portion  of  the  plate  a  piano  Avirc  is  attached  in  sucli  a  way 
as  to  bear  upon  the  inner  corner  of  tlie  tooth  to  be  turned, 
while  a  similar  wire  imbedded  in  tlie  buccal  portion  of  the 
plate,  is  arranged  to  press  u]»oii  tlie  corner  that  projects.  The 
bending  of  the  wires  from  time  to  time,  to  increase  the  ten- 
sion, will  speedily  accomplish  the  desired  result. 

Where  only  one  corner  of  a  tooth  stands  out  of  line,  the 
plate  just  descrilxHl  may  l)e  modifi(Hl  by  having  l)Ut  a  single 


PEACTICAL    TKKATMENT.  147 

wire  to  press  inward  the  outstanding  corner,  and  allowing  the 
rubber  plate  to  rest  firmly  against  the  corner  that  is  in  line, 
to  prevent  it  from  turning. 

Opportunity  for  the  projecting  portion  of  the  tooth  to 
move  inward,  must  of  course  be  provided  by  cutting  away 
the  rubber  plate  at  this  [)oint. 

Another  way  of  rotating  a  tooth,  is  to  fit  a  band  or  ferrule 
of  gold  or  platinum  to  it,  with  a  headed  i)latinum  tooth-pin 
soldered  to  its  labial  face  near  the  angle  that  is  out  of  line. 
A  delicate  vulcanite  plate  is  then  made  to  fit  the  roof  of  the 
mouth,  and  into  it  at  a  suitable  point  is  screwed  a  threaded 
gold  wire  with  a  slight  curve  or  hook  on  its  end.  After  the 
band  is  cemented  to  the  tooth,  it  is  connected  with  the  gold 
hook  in  the  plate  by  means  of  a  rubber  ring.  Should  it  be 
desirable  to  change  the  point  of  attachment  on  the  plate,  it 
can  be  done  by  drilling  a  new  hole  at  the  desired  point,  and 
screwing  a  hook  into  it.  The  plate  can  be  removed  for 
cleansing  and  new  rubber  rings  applied  by  the  patient. 

To  avoid  the  inconvenience  of  wearing  a  plate  during 
the  school-age,  the  author  many  years  ago  devised  a  small 
and  inconspicuous  appliance  for  rotating  a  sin-       pj,-,   g?. 
gle  incisor.     It  is  shown  in  outline  in-  Fig.  87,        -^ 
and  is  constructed  as  follows :  ^^^^^>^^y 

A  strip  of  platinized  gold  about  an  eighth  of  -riie  aiuIioi-s 
an  inch  in  width,  and  gauge  Xo.  24  in  tldck-  ^^^^^^^^  D^^i^e. 
ness,  is  bent  to  conform  to  the  outline  that  we  wish  the 
turned  tooth  and  its  neighbor  to  describe  when  in  normal 
position.  Each  end  of  this  strip  is  bent  to  partly  encircle 
the  di.sto-palatine  angle  of  each  tooth,  after  which  another 
strip  of  gold,  of  similar  width  but  thinner,  is  soldered  to  the 
centre  of  the  first  piece.  This  last  piece  should  be  long 
enough  to  extend  between  the  teeth  and  embrace  the  pro- 
truding edge  of  the  tooth  to  be  turned. 

By  bending  this  arm  so  short  that  the  ai)plianceAvill  have 
to  be  sprung  into  place,  pressure  is  brought  to  bear  upon  the 
tooth  that  \\\\\  cause  it  to  rotate  in  its  socket.     The  appliance 


148  ORTHODONTIA. 

should  be  removed  each  day,  tlie  length  of  the  arm  shortened 
by  bending,  and  replaced.  To  guard  against  loss  or  accident, 
a  ligature  of  sewing  silk  should  be  tied  around  the  neck  of 
one  of  the  teeth  and  made  fast  to  the  appliance.  About 
ten  days  will  usually  suffice  to  bring  the  tooth  into  proper 
position. 

Tlie  teeth,  once  in  place,  are  readily  retained  by  means  of 
the  small  retainer  shown  in  Fig.  88.     In  its         Fig.  88. 
construction,  .similar  bands  are  made  to  fit 
both  the  corrected  tooth   and  its  neighbor, 

n,  i-1ji  --ti  11  1  The  Author's 

after  which  they  are  jomed  by  solder  at  the  Retaining  Fixture, 
point  where  they  touched  when  in  place.  To  add  stifiness, 
another  strip  of  gold  should  be  soldered  to  the  palatine  sur- 
face of  the  fixture.  When  completed  and  polished,  it  is 
lined  TNdth  phosphate  of  zinc,  and  placed  in  position  upon 
the  teeth. 

By  the  use  of  this  retainer,  which  occupies  but  little  space, 
the  tooth  is  held  so  rigidly  in  its  new  position  that  it  becomes 
firm  much  more  rapidly  than  it  would  under  other  circum- 
stances. Should  the  force  exerted  by  the  effort  of  the  cor- 
rected tooth  to  return  to  its  former  mal-position  be  so  great 
as  to  affect  the  tooth  used  as  anchorage,  this  tendency  may 
be  jDrevented  by  soldering  a  spur  of  gold  to  the  appliance  at 
a  suitable  point,  and  allowing  this  to  rest  against  some  firm 
tooth  near  by. 

A  case  in  the  practice  of  the  author  will  illustrate  a  ready 

means  of  correcting  an  extreme  case  of  torsion.     The  patient 

was  a  Japanese  bov,  nine 
Fig.  89.  ,.  ,        *' 

years  oi  age,  whose  upper 

denture,  when  he  applied 
for  treatment,  presented 
the  appearance  shown  in 
Fig.  89.  The  left  decidu- 
ous lateral  was  .still  in 
place,  while  the  right  per- 
manent   lateral  was  just 

Torsion  caused  by  Supernumeran-.  appearing      thrOUgh     the 


PRACTICAL    TREATMENT. 


149 


Fm 


Bands  and  Rubber  Ring  for  Rotation. 


gum.  Both  permanent  centrals  were  fully  erupted,  but 
owing  to  the  presence  of  a  supernunierarv  tooth  in  the  centre 
of  the  areli  the  right  central  Avas  crowded  far  out  of  its 
place  and  turned  on  its  axis. 

After  extracting  the  supernumerary  and  the  deciduous 
lateral,  platinum  bands  were  fitted  to  the  centrals,  with  a  gold 
hook  soldered  to  each  at  points  that  would  furnish  the  great- 
est amount  of  tractile  power. 
After  the  bands  were  cemented 
in  place  a  rubber  ring  was 
stretched  from  tooth  to  tooth,  in 
the  manner  shown  in  Fig.  00. 

The  malposed  tooth  was  thus 
readily  brought  into  contact 
with  its  fellow,  and  at  the  same  time  considerably  straight- 
ened.  Its  further  and  complete  rotation  was  then  accom- 
plished by  an  appliance  somewhat  similar  to  that  shown  in 
Fig.  87,  after  which  it  was  retained  h\  the  retainer  sliown  in 
Fig.  88.  As  the  left  central  had  been  somewhat  loosened  in 
the  act  of  rotating  its  fellow,  it  was  found  necessary,  in  order 
to  secure  stable  anchorage,  to  attach  a  spur  to  the  appliance 
and  have  this  rest  against  the  palatine  surface  of  the  right 
lateral,  which  was  by  this  time  almost  fully  erupted.  In 
six  months  the  teeth  were  firm  in  their  new  position,  as 
shown  in  Fig.  91. 

A  simple  and  very  effectual  method  of  accomplishing  the 
rotation  of  any  tooth,  without  regard  to  the  form  of  the 
crown,  and  one  too,  in  which  the  use  of  a  plate  is  dispensed 
with,  is  illustrated  in  Fig.  92. 

It  consists  of  a  platinum  or  gold  l^and  made  to  fit  the 
tooth  to  be  rotated,  and  having  Fig.  91. 

an  extension  bar  of  heavy  plat- 
inized gold  soldered  to  its  labial 
surface.  The  free  end  of  the  bar 
is  perforated  by  two  holes  for 

ligation     to     some     firm     tooth,  corrected  case. 

usually  a  molar.     In  use,  the  band  is  cemented  to  the  tooth 


150 


ORTHODONTIA. 


and  the  bar  sprung  down  and  ligated  to  the  tooth  selected 
for  anchorage.      The   immense  leverage  of   this  l)ar  will 

quickly    compel     the 


Fig.  92. 


tooth 
socket, 
becomes 
time    to 
can    l)e 


to    turn    in    its 

As    its     force 

spent    from 

time   the  bar 

bent    outward 


Spring  Bar  and  Band  for  Rotation. 


with  pliers,  without  re- 
moving it  from  the 
tooth.  After  the  tooth 
has  been  brought  into 
proper  alignment,  it  is 
most  conveniently  held 
in  position  Ijy  means  of  the  retainer  shown  in  Fig.  13.  It 
may  also  l^e  retained  by  a  rubljer  plate  having  a  gold  spur 
to  pass  between  the  teeth  and  rest  upon  the  portion  of  the 
tooth  that  has  been  moved  inw^ard. 

Prof.  Angle  has  improved  this  a})pliance  by  making  the 
band  and  bar  detachable. 

The  band  is  fitted  wath  a  section  of  German-silver  tubing 
soldered  to  its  labial  surface,  parallel  with  the  cutting  edge 
of  the  tooth.  Another  band,  with  a  hook  or  catch  soldered 
to  its  buccal  surface,  is  fitted  to  a  bicuspid  or  molar.  This 
latter  Ijand  also  has  a  piece  of  tubing,  soldered  horizontally 
to  its  palatine  surface,  through  which  is  passed  a  piece  of 
wire  intended  to  rest  against  the  two  teeth  adjacent  to  the 
one  banded  and  thus  afford  greater  resistance.  After  both 
of  these  bands  are  cemented  to  their  respective  teeth,  a 
straight  piece  of  piano  wire  is  inserted  in  the  tube  of  the 
tooth  to  be  turned,  and  bent  down  and  caught  in  the  catch 
on  the  other  tooth.  The  advantage  of  this  modification  is, 
that  a  weaker  or  stronger  wire  can  be  substituted  at  will,  and 
the  power  be  tlius  readily  controlled.  When  the  tooth  is  in 
proper  Hue,  the  wire  is  removed  and  replaced  by  a  shorter 
one  resting  upon  an  adjoining  tooth.     This  acts  as  a  retainer 


JM;  ATTICA  I.    TREATMENT. 


151 


Fig.  93. 


This   wire 
Fig.    !)4. 


by  keejtiii^ii,-  tlic  tootli   in  position  until  it  lias  grown  firm. 

The    retaining   wire   is 

secured  ])y  means  of  a 

pin,  inserted    in   a   hole 

drilled   through    l)oth 

tuhe  and  wire.    Dr.  Far- 

rar's  [)lan  of  })rocUu'ing 

single  rotation  is  shown 

in  Fig.  1)3. 

.     A  shp-noose,  made  of 

Tery  thin  gold   or  l^Iati-  Farmr's  Appli^mee  for  Rotation. 

iium  about  one-twelfth  of  an  inch  in  width,  has  a  threaded 
gold    wire  and  nut  soldered    to  its    free  end 
and  nut  engage  with  a  stri})  of  gold  plate, 
bent  to  conform  to  the  lingual  surfaces  of  at 
least  two  teeth  on  either  side  of  the  tooth  to 
be  operated  upon,  as  shown  in  the  illustra- 
tion.     The  turning  of   the  nut  draws  the 
protruding  angle  of  the  tooth  inward.     The  noose  and  bar 
are  shown  separately  in  Fig.  94. 

DOUBLE  TORSION. 

Where  two  adjoining  teeth,  as  the  superior  centrals,  are  to 
be  rotated  in  opposite  directions,  a  single  appliance  will  often 
accomplish  both  movements  at  the  same 
time.  The  appliance  devised  by  the  author 
for  this  purpose  is  shown  in  Fig.  95,  and  the 
details  of  construction  in  Fig.  96.  It  is  a 
modification  of  the  appliance  for  single  rota- 
tion shown  on  p.  147.  To  adapt  it  for  duty 
in  turning  two  teeth,  instead  of  the  single 
strip  of  gold  passing  between  the  teeth, 
two  strips  are  bent  in  the  form  of  "  b  " 
and  "  c."  These  are  made  long  enough 
to  be  bent  slightly  over  the  labial  surfaces 
of  the  teeth  to  be  turned,  extend  along  the  mesial  surface  to 


Fig.   95. 


The  Author's  Device 
for  Double  Rotation. 


Fig 


152  OKTIIODONTIA. 

the  palatine,  and  then  along  this  latter  almost  to  the  distal 
angle.  After  being  properly  shaped  aeeording  to  the  model, 
they  are  clamped  together  and  soldered  along  their  contigu- 
ous surfaces.  This  part  is  then  placed  in  position  on  the 
model,  and  the  long  arms  bent  to  conform  to  the  inner  sur- 
face of  the  bar  "  a,"  after  which  it  is  removed,  soldered  to 
"  a,"  and  the  part  "  b  "  "  c  "  reduced  in  thickness  by  filing,  so 
as  to  occupy  as  little  space  between  the  teeth  as  possible. 
When  properly  constructed  the  labial  part  of  the  appliance 
will  rest  against  the  teeth  just  at  or  slightly  above  the  most 
prominent  part  of  their  convexity,  wliile  the  lingual  por- 
tion will  be  near  the  gum  but  not  quite  touching  it,  and  the 
slightly  curved  ends  of  this  part  will  catch  just  above  the 
little  prominence  usually  found  at  the  disto-palatine  angle 
near  the  gum. 

Thus  made  and  placed,  the  piece  cannot  become  displaced 
by  the  lip  or  tongue,  except  when  it  has  become  loosened 
by  the  moving  of  the  teeth.  As  will  readily  be  seen,  by 
its  use  force  is  brought  to  bear  upon  four  points  of  the 
two  teeth  at  one  time,  acting  as  a  double  lever  upon  each 
tooth. 

A  valuable  feature  of  the  appliance,  had  in  view  in  its 
devising,  is  that  it  occupies  but  one  interdental  space,  and 
thus  more  readily  favors  the  turning  of  teeth  that  are  more 
or  less  crowded. 

In  use,  the  patient  should  l;e  seen  each  day,  the  fixture 
removed  and  tightened  by  bending  the  long  arms  slightly 
toward  the  smaller  ones  and  sprung  into  place. 

To  facilitate  its  introduction  in  the  first  instance,  a  piece 
of  rubber  should  be  placerl  between  the  teeth  one  day  pre- 
vious to  the  insertion  of  the  appliance. 

As  in  the  case  of  the  appliance  for  single  rotation,  a  thread 
should  be  tied  around  one  of  the  teeth  and  attaclied  to  the 
front  bar  to  guard  against  the  swallowing  or  lo.ss  of  the 
piece.  Fig.  07  rej)resents  a  case  of  double  torsion  which  was 
corrected  in  ten  days  time  by  the  use  of  the  appliance  just 


PRACTICAL    TKEATM  ICXT. 


153 


described,  the  patient  l)eiiig  seen  every  <]ay  ;  while  Fio;.  98 
shows  the  completed  operation.     After  tlie  teeth  are  in  posi- 

Fio.   97.  Fio.   98. 


Corrected  Case. 


Fig.  99. 


Double  Rotation. 

tion,  they  may  be  retained  by 
means  of  the  retainer  shown  on 
p.  80,  Fig.  15, or  a  vulcanite  plate 
with  gold  "  T  "  inserted  (Fig.  99), 
may  be  used  instead.  The  for- 
mer has  the  advantage  of  hold- 
ing the  teeth  more  firmly,  while 
the  latter  occupies  but  one  in- 
terdental space. 

When  the  distal  corners  of 
the  teeth  project  instead  of  the 
mesial,  the  appliance  described  Retaining  piute. 

is  rendered  equally  serviceable  by  reversing  its  position  and 
placing  the  long  arm  on  the  laljial  surface.  Fig.  100  repre- 
sents a  case  of  this  character,  while  Fig.  101  shows  the  rub- 
ber plate  with  gold  wire  bow  that  was  used  to  retain  the 
teeth  after  correction. 

Prof.  Angle  has  devised  a  very  sim})le  and  effectual 
method  of  accomplishing  double  rotation,  where  the  mesial 
angles  protrude.  Upon  each  of  the  teeth  to  be  rotated  he 
places  Magill  bands  with  tubes  soldered  to  their  labial  faces 
near  the  distal  angles.     One  tube  is  set  vertic-ally  and  the 


154 


OKTIIODONTIA. 


other  liori/.ontall y.     A  sliort  piece  of  piano  or  German  silver 
wire,  l)ent  to  a  right  angle  at  one  end,  is  inserted  into  these 

Fig.  101. 


Fi<i.  100. 


Torsion  of  Centrals,  with  Distal  Angles 
pointing  Outvviud. 


Fro.    lU-2. 


Angle's  Appliance  for  iJouble 
notation. 


Ketaining  Plate  on  CorreL'ten  La;;e. 

tubes,  and  rotation  is  effected  by 
the  elasticity  of  the  wire.  The 
device  is  shown  in  Fig.  102. 

Once  in  position,  the  teeth  are 
retained  by  inserting  in  the  tubes 
a  suitably  shaped  piece  of  non-elas- 
tic gold  wire. 

Dr.  King.'^ley  *  accom- 
plislies  the  same  result 
l)y  the  use  of  a  vulcanite 
])late  and  an  elastic  rub- 
1  )er  l)and.  Into  the  plate 
at  convenient  p  o  i  n  t  s , 
are  inserted  gold  hooks 
and  staples,  and  over 
these  and  around  llu' 
teeth  the  rubber  l)aiid 
is  woven  in  such  a  way 
as  to  ])ress  outward  the 
instanding    corners    of 

Kingsley's  Vulcanite  Plate  and  Elastic  Band.      j^J^^    incisorS.       Fig.    103 

well  illustrates  tlie  device. 


*  Loc.  cit.,  p.  103. 


CONTRACTION    OF  THE   ARCH. 

A  coiitracted  arch  may  be  due  to  lack  of  development, 
caused  by  late  or  ]nal-eru})tion  of  some  of  the  teeth  ;  to  the 
loss  of  certain  of  tlie  })ermanent  teeth  soon  after  their  erup- 
tion ;  or  to  mal-position  of  the  teeth  in  the  o})})osite  jaw. 

Tlie  late  eruption  of  the  superior  cus})id  teetli,  where  their 
spaces  have  been  pre-occupied  by  teeth  anterior  and  j)os- 
terior  to  tliem,  is  })erlia})S  tlie  most  frecpient  cause  of  this 
deformity. 

In  some  cases,  the  contraction  is  limited  to  the  molar  and 
bicuspid  region ;  in  others,  to  tlie  anterior  alone ;  while  in 
others  still,  the  entire  arch  needs  expansion. 

The  enlargement  of  the  arch,  either  at  certain  points  or  in 
its  entirety,  may  be  accomplished  Ijy  a  variety  of  methods. 

Where  lateral  expansi(jn  is  desired,  it  may  usually  be 
brouglit  about  in  a  simple  manner  by  the  use  of  the  Coffin 
split-i)late,  the  construction  and  operation  of  which  are 
described  on  }).  101. 

Another  form  of  appliance,  intended  to  accomplish  the 
same  purpose  and  constructed  of  piano  wire  and  vulcanite, 
has  been  devised  by  Dr.  Talbot,  and  is  illustrated  in  Figs. 
104  and  105. 

In  his  description.  Dr.  Talbot  says :  *  "A  (vulcanite)  plate 
is  made  to  fit  the  teeth  and  alveolar  process,  and  cut  away 
so  that  the  anterior  parts  extend  far  enough  forward  to  en- 
close the  teeth  to  be  moved.  A  piece  of  (piano)  wire  is  bent 
into  either  of  the  forms  shown  in  Fig.  105,  wherein  "  a  "  is 
the  coil  and  fixed  point,  "  b  b  "  movable  arms  extending 
from  "a,"  and  "cc"  movable  arms  extending  from  "b  b." 

*  Tall)ot's  Irregularities  of  the  Teeth.     P.  129. 

(155) 


156 


ORTHODONTIA. 


Grooves  are  cut  into  the  anterior  and  posterior  parts  of 
the  plate,  to  correspond  with  and  receive  the  points  "  b  b  "  and 
"  c  c."  Holes  are  drilled  at  these  points,  and  the  wires  tied 
to  the  rubber  plates.  In  order  tliat  tlie  anterior  teeth  may 
Fic.  104.  Fig.  105. 


Talbot's  Appliance  for  Lateral  Expansion  Talbut  Springs. 

be  moved  with  the  greatest  force,  the  arms  are  so  adjusted 
that  the  greatest  pressure  is  exerted  on  the  anterior  parts  of 
the  plates.  This  appliance  is  readily  removed  for  cleansing, 
and  returned  to  place  by  the  patient.'' 

Where  more  force  is  required  than  can  be  obtained  from 
either  of  the  appliances  just  described,  it  can  be  had  by 
the  more  direct  power  of  the  jack-screw,  operating  upon 
the  portions  of  a  rubber  plate  lying  next  to  the  teetli  to  be 
moved. 

Dr.  Kingsley's  neat  and  effective  appliances  of  this  char- 
acter are  shown  on  p.  143. 

The  use  of  the  jack-screw  in  the  lower  jaw  would  appear 
to  be  objectionable  on  account  of  its  being  in  the  way  of  the 
tongue ;  but  experience  has  proven  that  this  objection  is,  in 
fact,  a  slight  one. 

The  use  of  the  .screw  hastens  the  operation,  and  thus  les- 
sens tlie  period  of  inconvenience  in  any  given  case. 

When  expansion  of  the  anterior  portion   of  tlie  arch    is 


PRACTICAL    TREAT^[ENT. 


157 


Goddard's  Split  Vulcanite  Plate. 


desired,  it  may  be  accoin}>lislied  by  means  of  the  appliance 

shown  on  p.  122,  or  by  a  modification  of  the  Coffin  split  })]ate 

devised  by  Prof.   C.  L.  (Jod- 

dard.     TliV  latter  is  shown  in  ^'''-  ^^^'■ 

Fig.  1()(). 

As  will  be  seen,  there  are 
two  corrugated  piano  wires 
attached  to  the  rul)ber  plate, 
one  on  each  side  near  the  free 
margins,  while  the  plate  is 
split  laterally  just  back  of  the 
incisor  teeth.  As  in  other 
split  i)lates  for  anterior  ex- 
pansion, this  plate  is  made  in 
one  piece  and  the  wires  ar- 
ranged so  that  their  anterior 
ends  are  imbedded  in  the  portion  to  be  detached,  while  the 
posterior  ends  are  fastened  to  the  main  body  of  the  plate. 
After  the  completion  of  the  plate  the  front  portion  is  sepa- 
rated by  means  of  a  jeweler's  saw,  and  pressure  is  produced 
by  stretching  the  wires  from  time  to  time. 

The  anterior  portion  is  kept  down  to  its  place  by  being 
ligated  to  the  central  incisors.  In  using  this  form  of  plate 
the  author  has  found  it  more  convenient  to  hold  the  front 
portion  down  by  imbedding  hi  the  plate  a  gold  spur,  to  pass 
between  the  centrals  in  the  free  space  near  the  gum.  He 
also  prefers  to  secure  the  main  portion  in  position  by  making 
the  plate  to  cover  and  grip  the  bicuspids  and  molars,  as  in  the 
Coffin  method,  instead  of  fastening  it  to  the  side  teeth  with 
ligatures.  The  aj^pliance  is  most  admirably  adapted  to  the 
purpose  for  which  it  was  devised. 

Dr.  Bonwill's  appliance  for  producing  anterior  expansion 
of  the  arch  possesses  certain  features  not  met  with  in  other 
appliances.  Fig.  107  represents  the  device  in  position,  but 
not  under  tension.*  "  It  is  made  of  two  flat  bars  of  platinized 
gold,  sliding  over  each  other  for  at   least  two  inches.     A 


*  Gorgas'  Harris  Principles  and  Practice,  p.  467. 


158 


ORTHODOXTIA. 


loop  is  soldered  to  tlie  end  of  each  flat  bar  as  guides,  to  hold 
them  in  position  while  sliding  through.  A  rubber  band  is 
shown    attached  to  tlie  end  of  each    bar   at  A  A,  which, 

in  contracting,  en- 
^^^''-  ^*'''-  larges    the    circle, 

and  consec|uently 
not  onh'  throws 
out  the  incisors,but 
the  bicuspids  and 
cuspids  as  well. 

"The  attach- 
ments are  made 
on  either  side  to  a 
molar  or  bicuspid, 
owing  to  the  ease 
of  clasping.  Be- 
fore the  api^aratus 
is  placed  f)6i'™ia- 
nently  in  position, 
the  four  incisors 
are  ligated  with  a  loop,  using  gum  sandarac  varnish  to  pre- 
vent slipping  or  turning  on  the  tooth.  These  are  now  tied 
to  the  sliding  bars,  bringing  the  latter  closely  in  contact 
with  all  the  teeth  intended  to  be  moved. 

"  The  ruljber  band  is  next  tied  between  the  two  points  A  A, 
and  the  application  is  complete." 

The  expansion  of  the  entire  arch  at  one  time  is  seldom 
called  for,  but  Dr.  Kingsley,  in  his  work,*  records  a  case  in 
which  he  accomplished  it  by  simply  inserting  rubber  wedges 
between  all  of  the  teeth  in  the  arch,  replacing  them  with 
larger  ones  as  space  was  gained.     See  Fig.  108. 

Prof.  J.  B.  Littig  has  accomplished  the  same  result  by  the 
use  of  wooden  wedges  instead  of  rubber. 

A  better  plan,  in  tlic  ()})iui()n  of  tlic  autlior,  where  expan- 
sion of  the   entire  arch   is  desired,  is  to   accomplish  it  by 
separate  ojierations.      Lateral  ex]iansion,  for  instance,  can 
*Loc.  fit.,  p.  12P. 


Bonwill's  Appliance  for  Anterior  Expansion. 


PRACTICAL    TKEAT.M  KXT. 


159 


Fig.  108. 


be  aeeoinplished  first,  and  after  the  l)iciLspids  and  molars 
liave  been  brought  into  proper  position,  tliey  may  be  retained 
by  means  of  a  rubber  plate  covering  tlicm.  This  plate  will 
not  only  hold  them 
firmly,  but  serve 
as  an  anchorage  to 
which  other  fix- 
tures may  be  at- 
tached for  the  ex- 
pansion of  the  an- 
terior portion  o  f 
the  arch,  as  in  the 
Goddard  plan. 

The  details  of  a 
case  of  general  ex- 
pansion of  the  su-  - 
})erior  arch,  may 
be  of  interest  to 
the  student.      The 

,  •        ,  1  Expansion  of  Arch  hj'  Rubber  Wedges  (Kingsley). 

patient  was  a  boy 

of  about  fifteen  years  of  age.  The  inferior  arch  was  of 
normal  size,  with  the  teeth  well  arranged.  In  the  superior 
arch,  all  of  the  teeth  except  the  cuspids  articulated  inside 
of  the  lower  ones,  giving  the  patient  a  pinched  or  contracted 
appearance  in  the  region  of  the  upper  lip.  The  laterals  were 
almost  in  contact  with  the  first  bicuspids,  while  the  cuspids 
had  fully  erupted  outside  of  the  arch  and  were  overlying 
the  laterals. 

Extraction  was  not  indicated,  for  all  of  the  teeth  were 
needed  to  fill  the  arch  after  its  expahsion. 

By  means  of  a  Coffin  split-plate,  lateral  expansion  was 
accomplished  in  about  a  month,  so  that  the  bicuspids  and 
first  molar  on  each  side,  occluded  normally  with  those  be- 
low. Next,  with  another  Coffin  solid  plate  encasing  the 
teeth  that  had  been  moved,  and  with  two  piano  wires 
attached,  the  laterals  were  pressed  forward  ;  after  which,  new 


100  ORTHODONTIA. 

rubber  was  added  to  the  plate  to  keej)  these  teetli  in  position, 
and  the  wires  ehanged  to  press  the  centrals  forward  into  line 
with  the  laterals.  After  this  had  been  accomplished  there 
was  still  insufficient  space  for  the  accommodation  of  the  cus- 
pids, and  as  the  incisors  were  ah^eady  so  far  forward  that 
pressure  could  not  advantageously  be  brought  to  bear  upon 
them  from  the  rear,  another  plan  for  increasing  the  cuspid 
space  was  decided  upon.  Magill  bands  were  made  to  fit  the 
laterals,  with  a  gold  spur  extending  along  the  palatine  sur- 
faces of  the  centrals  to  insure  uniform  movement  of  the 
four  incisors.  Platinum  bands  were  also  attached  to  the 
first  Ijicuspids.  All  of  these  bands  we  re-enforced  with  an 
additional  piece  of  platinum  soldered  to  the  portion  next  to 
the  space.  Through  these  re-enforcements,  at  about  the 
centre  of  the  tooth,  holes  were  drilled  entirely  through  the 
bands.  Piano  wire  was  next  bent  into  the  form  of  small 
U-shaped  springs  with  the  ends  at  right  angles,  similar  to 
Dr.  Talbot's  plan,  but  without  the  coil.  Grasping  these 
near  the  neck  with  a  pair  of  narrow-beaked  right-angle  forceps, 
transversely  grooved  near  the  points  to  seize  the  wire,  the 
springs  were  placed  in  position  with  their  ends  resting  in 
the  holes  of  th e  bands.  As,  from  time  to  time,  the  force  of  th ese 
springs  became  spent,  they  were  removed  and  their  power 
renewed  by  enlarging  their  curves.  Sufficient  additional 
space  having  been  gained  by  their  use,  the  cuspids  were 
forced  into  position  by  means  of  a  Coffin  plate  with  wires 
attached  to  the  buccal  surfaces,  extending  forward  and  rest- 
ing uj^on  the  labial  surfaces  of  the  cuspids. 

The  appearance  of  the  arch  and  teeth  with  the  U-springs 
in  position,  is  shown  in  Fig.  109.  The  operations  were  not 
hurried,  and  consumed  about  one  year's  time. 

A  retaining  ])late  of  vulcanite  covering  the  roof  of  the 
mouth,  with  gold  loops  attached  to  overlie  and  retain  the  cus- 
pids, is  now  l>eing  worn. 

Another  case,  differing  somewhat  from  the  one  just  given, 
was  tliat  of  a  young  girl  about  eleven  years  of  age,  whose 


PRACTICAL    TKEATM  KNT. 


IGl 


Fui.   109. 


superior  arch  did  not  need  lateral  expansion,  but  required 
anterior  enlargement  to  accommodate  the  in-coming  cuspids. 
False  occlu- 
sion of  the 
superi(^r  in- 
cisors a  Iso 
needed  c  o  r  - 
rection.  Fig. 
110  r  e  p  r  e  - 
sents  the  case 
as  it  presen- 
ted. The  su- 
perior c  e  n  - 
trals  met  the 

loWPT      n  n  P  S  Increasing  Space  by  Curved  Spring  and  Bands. 

edge  to  edge,  while  the  superior  laterals  passed  inside  of 
the  lower  ones.  There  was  very  little  room  between  the 
superior  laterals  and  first 
bicuspids  to  accommodate 
the  cuspids,  which,  slow 
of  eruption,  were  just  be- 
ginning to  make  their 
appearance. 

The  treatment  required 
was  the  moving  of  the  lat- 
erals and  centrals  so  as  to 
overbite  the  lower  ones, 
and  the  moving  backward  of  the  bicuspids  on  each  side,  to 
afford  space  for  the  cuspids.  The  laterals  were  first  moved 
forward  in  line  with  the  centrals,  by  means  of  the  jdate 
shown  in  Fig.  111.  This  accomplished,  the  anterior  |)ortion 
of  the  arch  was  expanded  by  a  Goddard  split  plate. 

A  plain  rubber  plate,  covering  the  arch  and  touching 
each  tooth  was  next  made,  and  into  it  were  secured  on  either 
side  pieces  of  piano  wire  bent  to  a  right  angle  at  their  free 
ends,  the  bent  portions  being  arranged  to  rest  upon  and  press 


Fig.   110. 


Case  Requiring  Anterior  Expansion. 


162 


ORTHODONTIA. 


Fig.  111. 


against  the  mesial  surfaces  of  the  first  bicuspids  to  force  them 
backward.  The  plate  having  been  trimmed  to  admit  of  the 
backward  movement  of  the  bicuspids,  full  space  for  the  cus- 
pids was  soon  gained. 

The  slow  eruption  of  the  cuspids   required  a  retaining 

l»late  to  l)e  made,  armed 
with  gold  spurs  at  suitable 
points,  to  keep  the  regu- 
lated teeth  in  their  new 
positions  and  await  the  full 
eruption  of  the  cuspids. 
Til  is  is  now  being  worn. 

In  the  course  of  six 
montlis  or  less  the  cus- 
pids   will   prol)ablv   have 

Coffin  Plate  for  pressing  Laterals  forward.  •  i     i'         i      • 

assumed,  unaided,  tlieir 
proper  places  in  the  arch,  and  by  their  key-like  position 
will  preserve  the  present  arrangement  without  the  further 
aid  of  any  retentive  appliance. 

The  case  had  previously  been  in  the  hands  of  two  den- 
tists, who  began  operations  for  correction,  and  it  therefore 
became  necessary  for  the  author  to  carry  it  forward  to 
completion. 

Had  he  been  consulted  in  the  beginning,  he  would  have 
advised  non-interference  until  two  years  later,  when  the  cus- 
pids would  have  been  partially  erupted,  and  more  nearly 
ready  to  assume  their  places  in  the  arch,  as  soon  as  room 
was  provided. 

In  this  way  the  wearing  of  a  retaining  plate,  to  await  the 
full  eruption  of  the  cuspid.s,  would  have  been  avoided  and 
the  case  simplified. 


CHAPTER  ^^III. 

PKOTRUSION  OF  THE  UPPER  JAW. 

The  causes  tending  to  produce  this  condition,  have  been 
briefly  considered  on  p.  22. 

There  are  two  varieties  of  this  deformity  : — 

Isf.  Where  tlie  lower  teeth  are  in  line  forming  the  normal 
curve,  while  the  upper  ones  pass  over  and  beyond  them  in 
such  a  way  as  not  only  to  interfere  with  enunciation,  but  also 
to  render  them  almost  unserviceable  in  mastication.  This 
form  is  usually  attributable  to  inheritance ;  to  the  abnormal 
size  of  the  teeth  in  the  superior  arch  ;  or  to  the  mechanical 
influence  of  pressure  on  the  part  of  the  posterior  teeth.  It  is 
the  one  most  easily  corrected,  on  account  of  the  o})erations 
being  confined  to  a  single  arch. 

2nd.  Where  the  lower  incisors  are  flattened  in  outline  or 
introverted,  and  the  superior  ones  extend  so  far  forward  as 
to  leave  a  large  space  between  the  two  when  the  jaws  are 
closed.  In  this  case,  the  superior  protrusion  appears  to  be 
greater  than  it  really  is,  on  account  of  the  superior  and  in- 
ferior teeth  inclining  in  different  directions.  Where  there 
is  introversion  of  the  inferior  incisors  we  generally  find  their 
cutting  edges  on  a  higher  plane  than  that  of  the  neighbor- 
ing teeth.  This  does  not  signify  that  these  teeth  are  elon- 
gated, but  simply  that  their  position  causes  them  to  reach  a 
higher  level. 

This  condition  is,  in  most  cases,  due  to  the  habit  of  thumb- 
sucking,  the  thumb  pressing  the  lower  ones  in  and  the  upper 
ones  out  at  the  same  time. 

The  relative  height  of  the  cutting  edges  of  the  lower  in- 
cisors causes  them,  in  most  cases,  either  to  occlude  with  the 
base  of  the  crowns  of  the  superior  incisors,  or  to  come  in 
contact  with  the  soft  tissues  back  of  them.     This  condition 

(103) 


1G4 


ORTHODONTIA. 


seriously  complicates  the  niatter  of  correction,  for  it  inter- 
poses an  obstacle  to  the  inward  movement  of  the  superior 
teeth,  and  the  outward  movement  of  the  inferior  ones. 

Where  tlie  protrusion  is  slight  and  the  teeth  are  in  con- 
tact, space  for  their  inward  movement  may  sometimes  be 
obtained  by  dressing  off  any  discoloration  or  superficial  de- 
cay from  the  approximal  surfaces  of  the  six  anterior  teeth 
with  sand-paper  discs  or  emery-cloth  strips,  followed  by  thor- 
ough polishing. 

By  this  means  the  author  has,  in  a  few  instances,  materi- 
ally improved  the  i)atient's  expression,  without  loss  of  teeth 
or  injury  to  tooth-substance.  The  space  once  gained,  the 
teeth  can  easily  be  brought  inward  by  the  use  of  a  Coffin 
plate,  cut  away  posteriorly  to  the  incisors,  and  having  gold 
hooks  attached  to  the  anterior  portions  of  the  plate  on  the 
buccal  surface.  A  rubber  band  caught  over  the  hook  on 
one  side,  carried  along  the  labial  surfaces  of  the  anterior 
teeth,  and  attached  to  the  hook  on  the  opposite  side,  will 
generally  provide  the  required  tension.  Small  double  hooks, 
made  from  half-round  gold  wire  and  hung  over  the  cutting- 
edges  of  the  centrals,  will,  by  their  second  curves,  support 
the  rubl^er  band  in  proper  place  and  keep  it  from  resting 
upon  and  irritating  the  soft  tissues.  Other  simple  means 
for  effecting  the  same  result,  will  readily  suggest  themselves 
to  the  operator.  Where  the  protrusion  is  of  greater  extent 
and  the  teeth  are  in  contact,  it  will  be  necessary  in  most 
cases  to  sacrifice  a  bicuspid  or  molar  on  one  or  both  sides  of 
the  mouth  to  obtain  sufficient  space  to  enable  the  anterior 
teeth  to  be  moved  backward  into  line. 

After  the  extraction  of  the  tooth  or  teeth  it  is  well  to  draw 
backward,  by  easy  stages,  the  teeth  on  either  side  anterior  to 
tlie  space,  to  and  including  the  cuspids.  The  subsequent 
drawing  in  of  the  four  incisors  will  then  be  a  comparatively 
easy  matter.  In  inany  cases,  if  the  posterior  teeth  were 
used  as  anchoi'ages  for  the  inward  movement  of  six  or  ten 
anterior  teeth,  they  would  be  more  likely  to  move  forward 


I'K ACTIC A L    TRK AT>[ KNT. 


165 


Fig.  112. 


than  to  cause  the  anterior  ones  to  be  forced  l)ack\var(l,  on 
account  of  the  disparity  of  resistance. 

A  number  of  methods  for  moving-  backward  the  cuspid 
and  bicus})id  teeth  are  described  on  pp.  136  and  137.  A  simple 
plan  for  draAving 
in  tlie  four  supe- 
r  i  o  r  incisors,  i  s 
shown  in  Fig.  112. 
Platinum  1 )  a  n  d  s 
are   fitted    to    the 

laterals,    and    to  y^^\         ^^(^^^K'  ^^    ^^ 

their    labial    por-        llil^^      )  "^^W^^^^^l-  '  i;'^ 

tions  are  soldered 
extensions  of  gold, 
to  cover  and  rest 
upon  the  labial 

„     .  ,         Author's  Device  for  Retracting  the  Superior  Incisors. 

suiiaces  of  the  ad- 
joining centrals.  A  plain  rul  )ber  plate  is  also  made  to  cover 
the  palatine  arch,  with  a  gold  hook  inserted  in  its  centre. 
The  bands  being  cemented  in  place,  rubber  rings  are  slipped 
under  the  extensions  and  carried  to  a  point  between  the  cen- 
trals and  laterals,  where  they  are  drawn  in  and  over  the 
gold  hook  in  the  plate.  By  their  contraction,  all  four  of 
the  incisors  a  r  e 
drawn  inward  while 
but  two  of  them  are 
banded. 

A  plan  differing 
somewhat  from  the 
one  just  described,  is 
that  of  Dr.Kingsley's, 
illustrated  in  Fig. 
113.  The  band  over- 
lying the  incisors  is 

of  O-old  and  has  hooks  Kingsley's  GoIcI  Bar  and  Vulcanite  Plate  lor  Retraction. 

soldered  to  the  upper  edge,  to  pi'event  its  slipping  up  to  the 
gum.      It  is  also  htted  with   a   thin  strip  of  gold  to  pass 


Fig.  113. 


166 


(JirmODONTIA. 


Fig    114. 


between  the  centrals,  Avhile  its  free  end  is  connected  with 
the  centre  of  a  vulcanite  plate  by  means  of  a  ring  cut  from 
rubber  tubinu'.  This  ruljljer  ring  is  made  fast  to  the  plate 
either  by  means  of  a  ligature  or  by  slii)ping  it  into  a  horse- 
shoe slot  cut  in  the  plate  for  the  purpose. 

In  many  cases  the  elasticity  of  rubber  is  not  sufficient 
to  move  the  four  teeth  as  rapidly  as  desired.  In  such  an 
event,  the  direct  and  forcible  action  of  the  screw  may  be 
brought  into  play  by  means  of  the  device  of  Dr.  S.  G.  Perry, 

shown  in  Figure 
114.  It  is  a  vul- 
canite plate  cover- 
ing the  arch  and 
encasing  the  mo- 
lars, to  which  is 
attached  a  half- 
round  gold  wire 
bent  to  a  curve  and 
l^ng  enough  to  ex- 
tend a  1 o  n  g  the 
outer  surfaces  of 
the  teeth  from  mo- 
lar to  molar.  One 
end  of  this  curved  wire  is  j^ermanently  attached  to  the  vul- 
canite plate,  while  the  other  terminates  in  a  threaded  wire, 
which  engages  with  a  gold  nut  playing  in  a  slotted  recess 
of  the  plate  on  the  opjDosite  side.  Turning  the  nut  shortens 
the  bar  and  draws  the  teeth  inward. 

When  still  greater  power  is  demanded,  as  in  cases  where 
it  is  desired  to  draw  the  six  anterior  teeth  inward  by  one 
operation,  or  where  the  incisors  do  not  yield  readily  to  any 
i:>ower  that  can  be  applied  within  the  mouth,  anchorage  for 
resistance  must  be  obtained  outside.  Dr.  Kingsley,  we  be- 
lieve, was  the  first  to  suggest  and  utilize  the  back  of  the 
head  as  an  anchorage  for  appliances  intended  to  produce 
movements  of  the  teeth.  Illustrations  of  a  fixture  of  this 
character  will  lie  found  in  his  work,  |)p.  133  and  134. 


Perry's  Appliance  for  Ketractiou. 


PRACTICAL    TK  KATM  l<:XT. 


167 


])r.  J^'anar  al.-so  (U'vised  an  apparatus  for  the  same  pur- 
pose, but  it  is  somewhat  complicated  in  its  construction  and 
manner  of  adjustment. 

One  of  tlie  sini])lest  devices  of  tliis  character,  is  that  of 
Prof.  ( '.  L.  (iroddard.*  In  describing  the  construction  and 
use  of  his  a[)pliance,  lie  says:  "On  a  cast  of  tlie  su])erior 
incisoi-s  a  small  sheet  of  wax  was  placed,  covering  the  labial 
surfaces,  cutting  edges  and  part  of  the  lingual  surfaces.  In 
the  anterior  surface  of  this  wax  })late,  a  steel  wire  was  im- 
bedded, curved  to  conform  to  the  arch,  and  extending  later- 
ally about  one  inch  and  a  half  on  each  side.  The  ends  of 
this  wire  were  bent  in  the  form  of  hooks.  The  wax  plate 
and  wire  were  then  imbedded  in  a  flask  by  bending  the 
ends  of  the  wire  sufficiently  to  allow  them  accommodation 
inside  of  the  flask.  By  the  methods  usually  employed  in 
vulcanite  work,  a  plate 
was  thus  made  of  Idack 
rubber  with  the  Avire 
attached,  as  shown  in 
Fig.  115. 

"  When  placed  on  the 
patient's  teeth,  the  ends 
of  the  wires  projected  from  the  corners  of  the  mouth  on  each 
side  far  enough  to  permit  elastic  bands  to  connect  them 
with  a  cloth  cap  on  the  patient's  head  without  touching  the 
cheeks. 

"  The  ca})  was  so  shaped  that  the  elastic  could  be  attached 
to  it  in  two  })laces  on  each  side,  one  above  an(J.  one  below  the 
ear,  by  means  of  dress  hooks  sewed  to  the  cap  at  these 
points.  Round  silk  covered  elastic  cord  was  used,  and  the 
direction  of  the  force  could  be  varied  by  using  a  greater 
number  of  stands  above  or  Ixdow  the  ear,  according  to  the 
requirements  of  the  case.     The  amount  of  force  was  easil}^ 


Fig.  115. 


Goddard's  Steel  and  Vulcanite  Appliance  for 
Retraction. 


*  Annual  of  the  Universal  Medical  Sciences,  for  1888,  Vol.  III.,  pp.  547- 
551.     F.  A.  Davis,  Philadelphia,  publisher. 


108 


ORTHODONTIA. 


varied  by  shortening  or  lengtliening  tliese  cords.     Fig.  116 
shows  the  apphance  in  position. 

"  This  appliance  was  worn  at  niglit  <  »nly.  and  the  teeth  were 
soon  moved  back  to  the  desired  position.  Tlie  inferior 
incisors  striking  the  bases  of  the  sni^erior  ones,  as  they 
were  moved  back,  were  moved  with  tlicm.  After  the  teeth 
were  in  proper  position,  the  tension  of  the  elastic  cord  was 
slightly  lessened,  and  the  appliance  worn  at  night  for  a  few 
months  as  a  retaining  appliance  until  the  teeth  became  firm. 

Fio.  116. 


Goddard  Appliance  in  Position. 

"  The  greatest  usefulness  of  this  ap[>liance  is  in  cases  where 
there  are  no  teeth  in  the  mouth  sufficiently  firm  for  the 
anchorage  of  an  appliance  of  ordinary  form,  or  where  the 
teeth,  if  firm  enough,  are  of  such  shape  tliat  it  is  practi- 
cally impossible  to  fasten  appliances  to  them." 

The  author  recently  corrected  the  worst  case  of  superior 
protrusion  he  ever  met  witli.  using  an  apphance  differing 
from  Prof  Goddard's  only  in  certain  njinor  particulars. 


PRACTICAL    TREATMENT. 


109 


Superior  Protrusion  caused  by  Thumb-Sucking. 


The  patient  was  a  boy,  sixteen  years  of  age,  whose  supe- 
rior teeth  projected  beyond  the  lower  ones  at  least  three- 
quarters  of  an  inch.  The  inferior  incisors  were  relatively 
long,  and  their  cutting  edges,  in  occlusion,  imbedded  them- 
selves in  the  soft  tissues  of  the  palate  quite  a  distance  inside 
of  the  superior  teeth.  Botli  arches  were  wide  and  well- 
formed,  with  the  exception  of  the  superior  protrusion,  and 

all  the  teeth  were 

,      ,        T/-  Fig.  117. 

Ill     contact,      t^  ig. 

117  shows  the  re- 
lation between  the 
upper   and    lower 
teeth  at  the  time 
of  presentation  for 
treatment.     All  of 
the  teeth    b  e  i  n  g 
equally  good,  the 
first  bicuspids  were 
removed  to  create  space.     An  aj»pliance  of  vulcanite  and  wire, 
similar  to  Prof.  Goddard's,  was  then  made  ;  the  wire,  after  it 
was  properly  fashioned,  being  nickel-plated  before  vulcani- 
zation.    The  scull-cap,  instead  of  cloth,  was  made  in  skele- 
ton form,  of  inch-wide  black  silk  ribbon,  each  strip  being 
double  and  lightly  stuffed  witii  cotton  to  make  it  more  com- 
fortable to  the  patient.     The  elastics  used  were  the  ordinary 
flat  and  wide  rubber  bands,  cut  and  perforated  near  the 
ends  to  engage  with  the  hooks  on  the  cap.     The  teeth  being 
large,  strong  and  firmly  set,  especially  the  cuspids,  moved 
slowly ;  but  in  live  months'  time,  by  the  use  of  the  above 
appliance  alone,  the  teeth  were  moved  back  into  proper  posi- 
tion, the  cuspids  coming  into  close  contact  with  the  second 
bicuspids.     The  cutting  edges  of  the  lower  incisors  were 
ground  off  somewhat,  to  enable  the  superior  ones  to  be 
moved  inward. 

The  boy  being  in  attendance  upon  school  at  the  time  of 
the  operation,  and  not  wishing  to  subject  himself  to  the  rid- 


170 


ORTHODONTIA. 


Fig.    118. 


icule  tliat  the  wearing  of  such  a  cons]:»icuous  appliance  would 
surely  luring  u})0)i  liim  on  the  part  of  his  schoolmates,  an 
accessory  appliance  was  devised  for  liim  to  wear  during 
school  hours.  It  consisted  of  a  tliin  silver  saddle  cover- 
ing the  protruding  centrals,  to  which,  on  the  lahial  surface 
near  the  terminations,  were  soldered  two  platinum  headed 
pins.  The  first  molars  were  fitted  with  platinum  hands,  to 
which  platinum  hooks  were  also  attached  on  the  buccal  sur- 
face.    The  bands  were  cemented  to  their  respective  teeth, 

while  the  saddle  was 
removable.  This  ap- 
pliance, in  position, 
is  shown  in  Fig.  118. 
In  use,  the  saddle 
was  placed  in  position 
and  the  pins  upon  it 
and  the  molar  bands 
connected  by  means 
of  thin  rings  cut 
from  French  rubber 
tubing  of  small  diam- 
eter. This  fixture  was 
simply  intended  t  o 
retain,  during  the 
day,  the  progress 
made  by  the  more 
})Owerful  appliance  at 
night.  It  Avas  put  on 
in  the  morning  before 
starting  for  school, 
and  after  school  hours 
was  replaced  by  the 
pressure  api)liance, 
which  was  worn  until 

Corrected  Case. 

morning. 
Both  a])])liances  were  removaljle  for  cleansing,  and  were 
readjusted  and  opci-aicd  by  the  patirnl  liimself     They  gave 


Day  Retaining  A|)pliance. 


Fig.  119. 


PRACTICAL    TREATMENT.  171 

liini  no  pain  or  inconvenience  to  speak  of,  and  required  very 
little  oversight  on  the  part  of  the  operator. 

The  day  appliance  is  now  being  worn  as  a  retainer.  For 
the  first  three  months,  it  will  l)e  worn  1)oth  day  and  niglit, 
and  for  the  succeeding  three  months  at  night  only. 

Fig.  119  shows  the  relation  of  the  teeth  after  the  operation 
was  completed. 


CHAPTER  IX. 

PROTRUSION  OF  THE  LOWER  JAW,  OR  PROGNATHISM. 

This  condition,  one  of  the  most  unsio-htly  of  dental  deform- 
ities, giving  to  the  individual  a  rather  inhuman  expression 
and  interfering  greatly  with  speech  and  mastication,  is  quite 
frequently  met  with.  The  causes  probably  responsible  for 
its  inducement  are  given  on  pp.  23  and  24. 

When  the  deformity  is  slight  it  may  be  corrected,  or  at 
least  modified,  by  pressing  the  lower  incisors  inward  and  the 
upper  ones  outward  ;  but  where  the  case  is  pronounced,  there 
seems  to  be  no  remedy  for  it  but  the  retraction  of  the  entire 
inferior  maxilla.  This  may  be  best  accomplished  by  using 
some  form  of  scull  cap,  and  connecting  it  with  a  padded 
chin  piece  by  means  of  strong  rubber  bands.  The  persist- 
ent contraction  of  the  rubber  will,  in  a  greater  or  less  time, 
dependent  largely  upon  the  extent  of  the  deformity  and  the 
age  of  the  patient,  bring  about  the  desired  change. 

In  the  accomplishment  of  this  retraction,  it  was  formerly 
supposed  to  be  brought  about  by  a  change  effected  at  the 
angle  of  the  jaw;  but  the  more  plausible  hypothesis,  is  the 
one  fir.st  advanced  by  Dr.  Geo.  S.  Allen,  namely :  That  the 
jjressure  applied  to  the  mental  region,  causes  resorption  of 
the  posterior  wall  of  tlie  glenoid  cavity,  thus  permitting  the 
condyles  to  recede  and  articulate  somewhat  posteriorly  to 
their  former  position.  This  theory  as  to  the  physiological 
change  brought  about,  is  supported  by  the  fact  that  an  alter- 
ation of  form  in  the  glenoid  cavity  is  more  readily  accom- 
plished by  resorption,  than  a  bending  of  the  maxilla  at  one 
of  its  strongest  points. 

An  interesting  case  of  retraction  of  the  lower  jaw,  was 
brought  before  the  Odontological  Society  of  New  York,  in 
1878,  bv  Dr.  Allen.     I  quote   important  points  from   his 

(172) 


PRACTICAL    TREATMENT. 


173 


description :  "  iVs  will  be  .seen  from  the  photograph  (Fig. 
120),  taken  at  the  time  she  was  wearing  this  apparatus,  it 
consists  of  two  parts.  For  the  lower  part,  I  made  a  brass 
l)late  to  tit  tlie  chin,  having  arms  with  hooked  ends  reaching 
to  a  })oint  just  below  the  point  of  the  chin.  These  arms 
Avere  arranged  in  such  a  way,  that  the  distance  between  them 
could  be  altered  at  will,  l)y  simply  pressing  them  apart  or 
together.     The  u})per  part  consisted  of  a  simple   network, 

Fig.  120.  . 


I   I  ower  Jaw. 


going  over  the  head  and  having  two  hooks  on  each  side,  one 
hook  being  above  and  the  other  below  the  ear.  When  this 
apparatus  was  completed  and  in  use,  there  were  four  liga- 
tures of  ordinary  elastic  rubber,  pulling  in  such  a  way  as  to 
force  the  lower  jaw  almost  directly  backward.  The  work 
proceeded  very  rapidly,  so  that  at  the  end  of  two  months, 
the  irregularity  was  almost  entirely  cured.  I  see  no  reason 
why,  in  all  such  cases,  either  this  or  similar  methods  of  pro- 


174 


ORTHODONTIA. 


Fig.   121. 


cedure  slioiild  not  be  adopted.  I  should  certainly,  if  any- 
similar  eases  presented  hereafter,  even  at  twelve  or  thirteen 
years  of  age,  before  attempting  any  other  procedure,  try  this 
first  and  thoroughly." 

The  Drs.  Winner,  of  Wihnington,  Del.,  have   furnished 

the  writer  with  models 
and  description  of  a 
case  somewhat  similar 
to  the  foregoing  (Figs. 
121  and  122).  In  their 
case,  the  patient  was  a 
boy  fourteen  years  of 
age,  tall,  slender,  pos- 
sessing good  g  e  n  e  r  a  1 
health,  but  only  fair 
i;)hysical  strength.  The 
models  show  that  there 
was  a  bicuspid  lacking 
on  each  side  above, 
while  below  there  still 
remained  two  tempo- 
rary molars.  He  stated 
that  he  had  never  had 
any  teeth  extracted  by 
a  dentist,  so  it  is  probable 
that  the  two  bicuspids 
were  never  erupted. 
The  superior  centrals 
were  considerably  worn 
away  on  their  cutting 
edges  and  labial  sur- 
faces by  attrition  with  the  lower  ones.  After  extracting 
the  deciduous  molars  below,  a  plate  was  made  covering  the 
upper  posterior  teeth,  and  so  arranged  that  in  addition  to 
furnishing  a  masticating  surface  while  the  teeth  were  apart, 
it  also  acted  as  an   inclined  plane  in  helping  the  lower  jaw 


Prognathism. 


Fig.  122. 


C;ise  Corrected. 


PRACTICAL    TREATMENT. 


175 


Fig.    123. 


to  move  backward.  From  first  to  last  he  wore  an  occipito- 
mental sling,  as  illustrated  in  Garretson's  Oral  Surgery,  in- 
creasing the  tension  from  slight  at  first  to  as  tight  as  could 
be  worn  without  too  great  discomfort.  At  the  end  of  nine 
weeks  the  articulation  was  normal,  but  the  sling  was  worn 
for  several  weeks  longer,  without  increased  tension,  to  retain 
the  satisfactory 
result  secured. 

Fig.  123  illus- 
trates the  most 
pronounced 
case  of  this  class 
of  deformity 
the  writer  has 
ever  met  with. 
The  patient  was 
a  man  of  about 
fortv    vears    of 

"  Excessive  Prognathism. 

age,    and     was 

brought  by  a  neighboring  dentist  for  consultation  as  to 
whether  anything  could  be  done  to  remedy  the  defect.  The 
lower  jaw  was  very  large  in  all  its  aspects,  while  the  upper 
was  correspondingly  small.  Although  the  lower  incisors 
inclined  decidedly  inward,  the  distance  from  the  cutting 
edge  of  the  lower  incisors  to  the  cutting  edge  of  the  upper 
in  a  horizontal  line,  was  a  little  over  half  an  inch.  From 
the  upper  jaw  there  were  missing  the  right  lateral,  second 
bicuspid  and  first  molar ;  while  on  the  left  side,  the  second 
bicuspid  and  tv/o  molars  were  absent.  In  tlie  lower  jaw,  the 
patient  had  lost  two  molars  and  a  bicuspid  on  the  left  side, 
and  the  first  molar  on  the  right.  All  the  teeth  of  the  upper 
jaw  passed  inside  the  lower,  except  the  first  bicuspids,  whose 
external  cusps  articulated  slightly  with  the  anterior  lingual 
cusps  of  the  opposite  molars  below. 

The  advanced  age  of  the  patient,  conjoined  with  the  con- 
ditions   just   described,   placed    his   case   beyond    surgical 


176  OKTIK^DOXTIA. 

remedy  and  ]\v  was  so  int'ornuMl.  A  ]»latc'  covering  and 
maskingthe  natnral  tooth  al)Ove  with  artihcial  tooth  niountod 
outside  to  artiouhito  with  the  lower  ones  was  suggested,  hut 
the  idea  (Ud  not  please  him.  and  ho  concluded  to  pass  the 
remaining  portion  of  his  life  as  ho  did  the  hrst,  so  far  as  his 
dental  apparatus  was  concerned. 


ClLVrTER  X. 


MISCELLANEOUS. 


LACK  OF  ANTERIOR  OCCLUSION. 


Fig.  124. 


In  certain  rare  instances,  cases  are  met  with  in  wliich 
the  anterior  teeth  do  not  come  in  contact  u])on  closure  of  tlie 
jaws.  The  bicuspids  and  mohirs  of  liotli  jaws  may  articu- 
late properly,  but  in  the  front  part  of  the  moutli  upon  occlu- 
sion, there  exists  a  space  more  or  less  great  between  the 
cutting  edges  of  the  incisors.  The  space  is  greatest  at  the 
median  line  and  gradually  diminishes  toward  the  cuspids. 
The  condition  not  only  gives  a  lisp  to  the  speech  of  the 
individual  but  renders  these  teeth  entirely'  useless  for  pur- 
poses of  mastication. 

At  first  glance  the  incisors  have  the  appearance  of  being 
too  short  in  their 
crowns,  but  an  exam- 
ination will  show  that 
they  are  of  normal 
size  and  length  and 
that  the  process  and 
possibly  the  maxilla 
itself  is  responsible 
for  the  shortened  ap- 
pearance. 

In  most  cases  it  will 

be     found     that     both  Lack  of  Anterior  Occlusion. 

arches  are  normal  in  form  and  size,  that  there  is  no  protru- 
sion or  introversion  eithei'  al)Ove  or  l)elow,  and  that  the 
superior  teeth    alone   are   at    fault.     Fig.  r24   represents  a 

(177) 


178  ORTHODONTIA. 

typical  case  of  this  character,  tlie  model  being  from  the 
collection  of  Dr.  H.  A.  Baker. 

Fortunately,  the  condition  is  seldom  met  with,  for  it  is 
tlie  one  of  all  others  tliat  is  least  amenable  to  successful 
treatment. 

The  cause  of  the  deformity  has  l;)een  variously  attributed 
to  thumb-sucking,  to  sleeping  with  the  mouth  open  and  to 
derangement  of  the  articulation  caused  by  ill-ad vi.sed  ex- 
traction of  some  of  the  posterior  teeth ;  but  while  all  of  these 
are  doubtless  responsible  for  the  condition  in  many  instances, 
it  is  probabty  more  frequently  caused  either  by  the  lack  of 
alveolar  development  in  the  incisor  region,  or  an  unaccount- 
able variation  in  the  plane  of  the  alveolar  border  of  the 
maxilla.  The  autlior  has  met  witli  no  cases  of  this  condi- 
tion that  bore  evidence  of  hereditary  transmission,  and 
therefore  believes  it  to  be  due  to  a  peculiarity  in  the  devel- 
opment of  the  maxilla,  originating  with  and  confined  to  the 
individual  him.self 

In  the  line  of  treatment,  so  far  as  the  author  is  aware,  but 
two  plans  have  been  adopted.  One,  where  the  deformity  is 
slight,  consists  in  grinding  off  the  cusps  and  antagonizing 
points  of  some  or  all  of  the  posterior  teeth  in  order  to 
shorten  the  bite  and  bring  the  anterior  ones  more  nearly 
together.  Mucli  of  tliis  cannot  be  done  without  denuding 
the  teeth  of  their  enamel  at  certain  i)oints  and  exposing  the 
sensitive  dentine,  but  done  in  moderation  it  will  often  aid 
quite  a  little  in  lessening  the  deformity. 

The  other  plan,  for  aggravated  cases,  is  to  produce  pressure 
upon  the  anterior  portion  of  the  lower  jaw  by  means  of  a 
skeleton  cap,  cliin-piece  and  rubber  bands,  very  similar  to 
the  appliance  used  in  retraction  of  the  lower  jaw,  only  that 
in  the  present  case  the  power  should  be  applied  in  an  almost 
vertical  direction.  Witli  such  an  apparatus,  worn  continu- 
ously for  a  few  months,  the  condyles  of  the  lower  jaw  will 
l)e  tipi»cd  somewliat  out  of  their  cavities  and  the  latter  be 
])artially  filled  up  with  new  ossific  material. 


^       PRACTICAL  TREATMENT.  179 

REDUCTION  OF  ELONGATION  OF  THE  ANTERIOR  TEETH. 

Normally,  each  tooth  will  advance  in  the  course  of  its 
eruption  until  the  whole  of  its  crown  projects  heyond  the 
free  margin  of  the  gum,  and  its  cutting  edge  or  masticating 
surface  is  in  proper  relation  with  the  same  surfaces  of  the 
adjoining  teeth.  Full  eruption  may  be  delayed  or  entirely 
prevented  by  accidental  circumstances,  but  extra  elongation 
will  not  occur  of  its  own  accord.  Wlien  it  does  occur,  it  is 
the  result  of  an  abnormal  condition  of  the  pericementum, 
most  generally  due  to  irritation  in  some  form,  or  it  is  caused 
by  lack  of  occlusion  with  teeth  in  the  opposite  jaw.  In  the 
latter  case,  it  is  but  the  manifestation  of  nature's  attempt  to 
rid  the  system  of  a  useless  organ. 

Elongation  of  one  or  more  of  the  superior  incisor  teeth 
sometimes  occurs  in  connection  with  regulating,  and  is  due 
either  to  the  irritation  of  the  soft  tissues  surrounding  the 
tooth  caused  by  the  impingement  of  the  regulating  api)li- 
ance  upon  them,  or  to  the  unfortunate  application  of  power 
in  such  manner  as  to  fovor  the  lifting  of  the  tooth  from  its 
socket. 

When  such  elongation  is  noticed,  it  becomes  necessary  to 
remove  the  cause  and  give  rest  to  the  affected  parts.  The 
elongation  being  due  in  the  first  instance  to  the  temporary 
thickening  of  the  peridental  membrane  through  irritation, 
a  period  of  rest  will  usually  result  in  the  subsidence  of  the 
trouble  and  the  return  of  the  tooth  to  its  former  position. 
Where  the  elongation  is  the  result  of  misdirection  of  power 
the  operation  will  have  to  be  suspended  for  a  time,  to  be 
followed  by  the  use  of  more  correct  appliances.  Should  the 
condition,  however,  be  allowed  to  continue  for  any  length 
of  time,  as  through  non-appearance  of  the  })atient,  some 
pressure  may  have  to  be  applied  to  force  the  tooth  back  into 
its  socket.  This  may  be  accomplished  in  a  very  simple 
manner  by  adopting  the  plan  suggested  by  Dr.  Wilhelm 
Herbst  for  retaining  a  replanted  tooth. 

It  consists  in  cutting  a  short  and    narrow  strip  from  a 


180 


()i;tih)ik)xtia. 


Herbst  Method  of  Retention. 


Fig.  1-2(). 


piece  of  rubber  dam  and  perforatiiiu-  it  in  such  manner  that 
when  in  position,  the  crowns  of  two  teeth  on  either  side  of 
the  one  affected  will  protrude  througli  the  openings,  while 
the  elongated  tooth  will  be  i>artly  covered  and  pressed  upon 
Fig.  1-25.  by  tile  intervening  i)ortion  of  the 

^      rubber.     Figs.  125  and  126  repre- 

!  -eait  the  strip  of  rubber  separately 

and  in  position.  Another  way  of 
producing  tension  upon  the  elon- 
gated tooth,  is  by  means  of  a  rub- 
ber plate  with  a  strip  of  gold  so 
attached  as  to  rest  and  press  upon 
tlie  cutting  edge  of  the  tooth. 

Neither   of    the   appliances  just 
mentioned  need  be  worn  long,  for 

Rubber  strip  Apilied.  .1  ,•  -n  •    i  1 

the  continuous  pressure  Will  CjUickiy 
cause  retrogression  of  tlie  tooth. 

ASSISTED  ERUPTION  OF  THE  ANTERIOR  TEETH. 

Incisor  teeth  that  have  not  erupted  to  tlieir  full  extent 
and  have  been  prevented  from  doing  so  by  too  close  prox- 
imity of  adjoining  teeth  or  other  cause,  may  often  be  assisted 
in  assuming  their  proper  alignment.  Where  sjjace  exists, 
teeth  will  naturally  accomplish  their  full  eruption  unaided, 
as  previously  stated.  When  they  do  not,  and  tliere  is  no 
visible  cause  for  their  not  doing  so,  we  may  safely  infer 
that  some  hindrance  exists  in  the  tissues  beneath  the  gum. 
It  may  only  be  an  unexplainable  suspension  of  the  act 
of  erudition,  or  it  may  be,  and  often  is,  a  curvature  or 
enlargement  of  the  root  that  prevents  the  further  progress 
of  the  tooth.  Which  of  tlie  two  it  is,  can  usually  only  be 
decided  after  measures  of  assistance  have  been  tried. 

If  the  delayed  eruption  has  been  due  simply  to  a  suspen- 
sion of  the  act  of  eruption,  the  simplest  and  most  effective 
remedy  will  be  found  in  tying  a  silk  ligature  around  the 
neck  of  the  tooth  and  pressing  it  avcU  under  the  free  margin 


rKACTICAI,    TKKATMKNT.  181 

of  the  gum,  or  in  placing  a  ring  cut  from  I'uhlxT  tubing  in 
the  same  iKisition.  Either  one  will  cause  irritation  of  the 
pericementum,  which  by  conse(|uent  enlargement  will  tend 
to  force  the  tooth  out  of  its  socket.  To  prevent  undue  elon- 
gation the  case  will  have  to  be  carefully  watched,  day  by 
day,  and  the  irritating  ligature  removed  as  soon  as  the  tooth 
has  been  sufficiently  elongated.  Should  this  be  neglected, 
the  tooth  might  be  entirely  ex})elled  and  lost. 

Should  these  simple  means  fail  to  move  tlie  tooth  from  its 
abnormal  position,  osseous  abnormality  is  probably  the  hin- 
dering cause,  and  mechanical  appliances  of  not  too  great 
power  should  be  tried.  Some  of  this  character  have  been 
mentioned  in  Part  III,  Cha])ter  2. 

Dr.  A.  E.  ^Nfatteson*  has  devised  an  a|)]tliance  for  produc- 
ing forced  elongation  of  several  of  the  incisor  teeth  at  the 
same  time.  It  is  comj)osed  of  a  rubl)er  jjlate  to  which  a 
piece  of  clock  spring,  properly  shaped,  is  attached.  The 
spring  is  cut  and  ground  along  its  outer  edge  in  such  nuui- 
ner  as  to  leave  projections  to  pass  between  the  teeth  at  their 
necks  and  l)ear  upon  the  wider  jiarts  of  the  crowns.  After 
being  properly  shaped  and  titted,  the  spring  is  riveted  to 
the'  anterior  portion  of  the  plate  just  back  of  the  teeth  to 
be  acted  upon.  In  inserting  the  appliance,  the  projections  of 
the  spring  are  passed  between  the  teeth  at  their  necks  and 
the  plate  pressed  into  place.  The  elasticity  of  the  slightly 
curved  s])ring  with  its  projections,  will  })roduce  pressure  upon 
the  teeth  in  the  direction  of  their  length  and  cause  their 
elongation. 

The  action  of  all  appliances  of  this  character  will  have  to 
be  closely  watched  to  see  that  the  power  produced  by  them 
is  not  too  great  nor  too  long  continued. 
^  Should  any  or  all  of  the  appliances  mentioned  tail  to 
move  the  partially  erupted  tooth,  we  may  safely  conclude 
that  its  root  is  exostosed  or  curved  at  some  point  of  its 
length,  and  further  operations  had  better  be  suspended. 

*  Harris'  Principles  and  Practice,  12  Ed.  p.  439. 


182  ORTHODONTIA. 

Tlie  author,  in  his  early  practice,  attempted  to  rotate  a 
superior  cuspid  tooth,  and  after  failing  to  produce  any  effect 
by  the  commonly  adopted  appliances,  concluded  that  the 
trouble  nuist  lie  in  the  formation  of  the  root.  A  digital 
examination  of  the  tissues  overlying  the  root,  revealed  the 
fact  that  it  Avas  considerably  curved,  and  further  efforts  at 
rotation  were  immediately  abandoned.  Had  tlie  examina- 
tion been  made  l)efore  beginning  operations,  as  it  should 
have  been,  instead  of  at  their  close,  much  annoyance  and 
trouble  would  have  been  spared  both  patient  and  operator. 
Where  full  eruption  of  a  tooth  has  been  made  imj)0ssible 
by  the  impingement  of  adjoining  teeth  upon  the  space  in- 
tended for  it,  increase  of  space  by  lateral  pressure  upon  the 
interfering  teeth  should  first  be  gained  before  any  attempt 
is  made  at  elongation.  Indeed,  the  mere  enlargement  of 
the  space  and  its  retention  for  a  length  of  time  will  usually 
be  followed  by  the  unaided  eruption  of  the  tooth.  Should 
this  not  occur,  mechanical  assistance  may  be  rendered  by 
some  of  the  methods  mentioned. 

Forced  eruption  of  a  tooth  by  means  of  the  extracting 
forceps  is  seldom  justifiable,  for  we  cannot  always  know 
what  may  have  interfered  with  the  eruption.  In  certain 
exceptional  cases,  where  a  careful  examination  reveals  no 
sign  of  malformation  of  the  root,  and  where  it  is  perfectly 
evident  that  slight  impingement  of  adjoining  teeth  has  been 
the  sole  hindrance  to  full  eruption,  the  forceps  may  prove  a 
valuable  means  of  effecting  a  raj)id  and  easy  correction  of 
the  difficulty. 

Fig.  127.  Such    an    exceptional    case 

^^^    r-.^-..  once  occurred  in    the  author's 

])ractice.       The   ])atient   was  a 
gentlemen    of    about     twenty- 
eight  years  of  age,  whose  right 
Incomplete  Eruption.  Central  iiicisor  was  about  a  line 

shorter  than  its  mate.  It  had  been  tardy  in  erupting  and 
in  consequence  there  was  a  slight  lack  of  space  for  its  ac- 
commodation, as  shown  in  Fig.  127. 


PRACTICAL    TREATMENT.  183 

As  the  difference  in  length  of  the  two  incisors  was  too 
great  to  be  remedied  by  the  simple  means  of  reducing  the 
length  of  the  longer  one,  it  was  decided  to  elongate  the 
shorter  one.  A  careful  examination  proving  favorable,  a 
piece  of  sand  paper  was  folded  so  as  to  cover  both  labial 
and  palatine  surfjices  of  the  tooth  to  protect  it  from  injury, 
after  which  it  was  gras})ed  with  the  force})S  and  by  a  combined 
rotary  and  downward  motion  brought  into  place.  Once  in 
position,  it  was  held  there  firmly  by  the  pressure  of  the  ad- 
joining teeth,  l)ut  as  good  judgment  would  not  sanction  so 
unreliable  a  means  of  retention,  an  ai)pliance  had  to  be 
devised  that  would  not  only  prevent  the  tooth  from  slip- 
ping back  into  its  socket  ]:)ut  also  secure  it  from  ])eing 
forced  forward  by  pressure  upon  its  sides.  The  patient  also 
desired  the  appliance  to  be  as  inconspicuous  as  possible. 

To  accomplish  all  of  these  ends,  a  piece  of  platinized  gold 
wire,  a  little  thicker  than  a  vulcanite  tooth-pin,  w'as  bent 
into  horseshoe  form  and  curved  to  conform  to  the  palatine 
surfaces  of  the  assisted  tooth  and  the  tw^o  adjoining  ones. 
The  ends  of  the  wdre  were  then  flattened  and  bent  so  that 
they  would  hook  over  and  rest  upon  the  cutting  edges  of 
the  adjoining  central  and  lateral.  A  silk  ligature  was  passed 
around  the  moved  tooth  and  tied  in  front,  after  whicli  the 
ends  were  again  passed  to  the  palatine  surface  and  tied 
just  below  the  cingulum.  After  the  gold  wire  was  placed  in 
position,  the  ligature  was  attached  to  it  at  the  low^est  point 
of  its  central  curve. 

The  ligature  thus  held  the  appliance  in  position  and  it 
in  turn  held  the  tooth  from  receding.     The  double  arrange- 
ment  of  wire   and    ligature   also  Fig.  128. 
guarded  the  tooth  against  the  pos- 
sibility of  moving  forward.      The 
fixture  in   position    is   shown    in 
Fig.  128.       The  only  parts  of  it 

visible     were     the     small     rounded  Retention  after  correction. 

gold  tips  that  overlapped  the  cutting  edges  of  the  two  adja- 
cent teeth. 


184  ORTHODONTIA. 

^\'here  sufficient  space  exists  for  the  purpose,  the  tooth 
after  being  drawn  into  position,  may  be  held  there  by  means 
of  the  phitinum  band  and  extension  bar,  as  shown  elsewhere 
for  retaining  a  tootli  that  has  been  forced  backward  into  the 
line  of  the  arch. 

TOOTH-SHAPING. 

During  tlie  act  of  regulating  or  after  its  accomplishment, 
one  of  the  most  useful  accessory  operations,  when  called  for, 
is  that  of  dressing  or  shai:)ing  certain  teeth  so  as  to  still 
further  improve  their  appearance. 

This  operation  will  probal»ly  not  be  necessary  in  the 
majority  of  cases  we  treat,  but  wlien  indicated,  it  adds 
immensely  to  the  patient's  appearance  and  the  satisfaction 
of  the  parents  and  operator.  It  may  be  accomplislied  by 
means  of  the  file,  corundum  point,  sand-paper  disk  or  emery 
cloth  strips,  each  having  its  value  according  to  the  require- 
ments of  the  case. 

It  will  not  often  be  called  for  on  the  approximal  surfaces 
of  teeth,  but  when  it  is,  much  of  the  sub.stance  should  not 
be  removed,  and  the  surface  .should  afterward  be  polished 
in  the  mo.st  perfect  manner. 

The  author  has  had  one  case,  and  one  only,  in  which  such 
trimming  of  approximal  surfaces  seemed  advisable.  The 
patient  was  a  young  lady  of  alxjut  twenty-one  years  of  age, 
whose  anterior  superior  teeth  were  slightly  prominent.  The 
teeth  were  without  interdental  spaces  and  all  of  the  j)osterior 
ones  were  so  perfect  in  structure,  alignment  and  occlusion, 
that  the  extraction  of  even  one  of  them  would  have  been 
regarded  as  an  unwarranted  sacrifice. 

All  of  the  six  anterior  teeth  had  small  cavities  upon 
each  of  their  approximal  surfaces,  and  it  was  therefore  decided 
that  in  the  filling  of  these  cavities  a  slight  portion  of  each 
approximal  surface  should  be  dressed  off  in  the  hope  that 
the  aggregate  of  such  spacing  would  be  sufficient  to  enable 
the  teeth  to  occupy  a  position  more  in  harmony  with  the 
normal  line  of  the  arch.      After  the  filling  and  dressing  of 


PRACTICAL    TREATMENT.  185 

tlie  surfaces,  the  teetli  were  drawn  inward  and  the  result 

was  all  that  could  have  been  desired. 

Sometimes  teeth  that  have  been  fully  erupted  out  of  line, 
when  ])rought  into  proper  position  extend  below  the  line  of 
the  cutting  edges  of  their  neighlmrs  and  the  rest  of  the  teeth 
in  the  arch.  Any  attempt  to  reduce  their  elongation  by 
forcing  them  up  into  the  socket  would  not  only  be  extremely 
difficult,  but  in  many  cases  futile.  The  better  plan,  if  the 
disparity  in  length  be  not  great,  is  to  grind  off  th?ir  cut- 
ting edges  somewhat,  and  thus  accomplish  the  desired  end 
in  a  very  simple  manner. 

In  other  cases,  teeth  out  of  line  have  from  lack  of  attri- 
tion preserved  their  normal,  rounded  form,  while  their 
fellows  have  been  more  or  less  worn  away  on  their  cutting 
edges  either  through  abnormal  occlusion  or  excessive  use. 
When  the  malposed  teeth  have  been  brought  into  position, 
their  rounded  and  unworn  cutting  edges  are  apt  to  contrast 
strongly  with  the  abraded  edges  of  their  neighbors.  By  so 
dressing  the  incisive  edges  of  the  unworn  teeth  as  to  resemble 
those  next  to  them,  greater  harmony  of  expression  Avill  be 
induced. 

Altering  the  form  of  a  tooth,  however,  may  often  be  made 
to  serve  even  a  more  useful  purpose  than  that  of  appear- 
ance. Cases  have  occurred  where  an  upper  tooth,  tardy  of 
eruption,  has  been  unable  to  come  entirely  down  into  line 
owing  to  its  meeting  its  antagonist  of  the  opposite  jaw  edge 
to  edge.  In  such  an  event,  the  retarded  tooth  might  be 
forced  sufficiently  outward  to  enable  it  to  accomplish  its 
full  eruption  and  then  be  held  in  such  position  until  over- 
lapping had  taken  place,  but  the  operation  may  be  advan- 
tageously simplified  in  most  cases  by  slightly  beveling  the 
edge  or  cusp  of  the  lower  tooth  on  its  labial,  and  the  upper 
one  on  its  palatine  surftice.  The  inclined  plane  thus  formed 
will  enable  the  upper  tooth  to  slide  over  the  lower  one  into 
line,  which  it  will  be  almost  certain  to  do  provided  there  be 
no  contingent  obstructions. 


1S()  ORTHODONTIA. 

A  case  of  this  character  came  under  the  author's  notice 

^    "recently  in  which  a  superior  lateral  incisor  was  thus  impeded 

in  eruption  until  the  individual  was  forty  years  of  age.     A 

simple  beveling  of  the  cutting  edge  of  it  and  its  opponent, 

caused  it  to  come  into  proper  line  within  a  year. 

Other  conditions  than  those  just  mentioned  will  occur  to 
the  practitioner  in  which  the  slight  alteration  of  the  form 
of  a  tooth  will  materially  assist,  or  be  the  means  of  entirely 
accomplishing  some  simple  act  of  regulating,  and  in  other 
cases,  greatly  add  to  the  effect  of  some  long  continued  and 
successful  operation  in  orthodontia. 


4?m 


■  M^.MmJ£!it^iiii'''i'ii.' 


